A novel approach using electroacupuncture for erectile dysfunction after radical prostatectomy: A case report.

INTRODUCTION: Research shows that electrical stimulation to damaged peripheral nerves has promising effects on nerve regeneration and recovery of function. DESCRIPTION: A 71 yr. old male, who was 12 months post left intrafacial and right incremental nerve sparing robotic radical prostatectomy received 6 sessions of sacral electroacupuncture/acupuncture at weekly intervals, commencing 12 months post operatively. METHODS: CARE guidelines informed the case study report. Positive changes in erectile function after electroacupuncture was recorded using validated scores (IIEF-5 and EHS). Qualitative information was collected via a feedback box. DISCUSSION: Given that current treatments for post radical prostatectomy erectile dysfunction are invasive and largely unsuccessful, further investigation into electroacupuncture for this population should be pursued.

Preoperative urinary function does not predict postoperative acute urinary retention in men after rectal resection.

AIM: Acute urinary retention (AUR) is a well-known complication after rectal surgery. It can be associated with additional morbidity. Causes of postoperative AUR are often multifactorial - involving patient-, pathology- and treatment-related factors. A proportion of men undergoing total mesorectal excision (TME) have preexisting urinary dysfunction and this may predispose to AUR. The aim of this study was to prospectively assess the influence of preoperative urinary function on postoperative AUR in men undergoing TME. METHOD: A prospective multicentre cohort study was conducted. All adult men undergoing rectal resection between June 2016 and January 2018 were recruited. Combined pelvic resections, inability to void per urethra and emergency surgery were excluded. Preoperative urinary function was assessed with uroflowmetry, prostate ultrasound and the International Prostate Symptom Score (IPSS). The incidence of postoperative AUR, urinary tract infection (UTI) and length of hospital stay (LOS) were measured. RESULTS: Seventy-seven patients (mean age 61 years) were recruited. The overall incidence of AUR was 21%. Preoperative urinary function, IPSS and past urological history were not predictive for postoperative AUR. AUR was not associated with UTI and did not affect LOS. Patients with UTI had a higher intravesical protrusion of the prostate. CONCLUSION: Preoperative urinary dysfunction in men is not predictive of postoperative AUR after TME. It should not preclude early trial of void after TME. AUR did not predispose to UTI, nor did it prolong LOS.

Análisis comparativo entre la enucleación prostática con láser de holmio y la adenomectomía laparoscópica en el tratamiento de adenomas prostáticos mayores de 100 g / Holmium laser enucleation versus laparoscopic simple prostatectomy for large adenomas

Objetivo: Realizar una comparación entre la enucleación prostática con láser de holmio y la adenomectomía por vía laparoscópica. Materiales y métodos: Se compararon los resultados entre 2 grupos de 20 pacientes cada uno (n = 40), los cuales fueron operados por adenomas prostáticos mayores de 100 g en nuestra institución. Al primer grupo se le realizó adenomectomía laparoscópica, mientras que al segundo se le realizó enucleación prostática con láser de holmio. Las variables estudiadas fueron la duración de la cirugía, el tiempo de cateterismo vesical en el postoperatorio y el tiempo de estancia hospitalaria, la puntuación de síntomas prostáticos y el flujo máximo preoperatorio y postoperatorio, así como también las complicaciones y el costo económico. Para el análisis estadístico se utilizó el test t de Student y el test de Fisher. Resultados: No hubo diferencias significativas entre ambos grupos en cuanto a la edad de los pacientes, el tamaño prostático, el tiempo quirúrgico y el peso de la pieza operatoria. La duración del cateterismo vesical postoperatorio (p = 0,0008) y el tiempo de estancia hospitalaria (p < 0,0001) fueron menores en el grupo del láser. Ambos grupos mostraron una mejoría significativa en las variables funcionales a los 3 meses posteriores a la cirugía. En cuanto al análisis del costo económico, cada caso del grupo holmio supuso 2.589 euros, versus 4.706 del grupo laparoscópico. Cuatro pacientes sufrieron complicaciones (20%) en el grupo del láser, mientras que se registraron complicaciones en 5 pacientes (25%) del grupo laparoscópico (p > 0,99). Conclusión: La enucleación prostática con láser de holmio posee similares resultados funcionales a corto plazo y complicaciones que la adenomectomía laparoscópica para el tratamiento de grandes adenomas, con la ventaja de ofrecer menos tiempo de cateterismo vesical y de estancia hospitalaria, así como también menores costos económicos

Objective: The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy. Materials and methods: We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n = 20) with laser enucleation of the prostate (n = 20) for large adenomas (> 100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test. Results: There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P = .0008) and hospital stay (P < .0001) were significantly less in the laser group. Both groups showed a statistically significant improvement in functional variables at 3 months post operatively. The cost utility analysis for Holmium per case was 2589 euros versus 4706 per laparoscopic case. In the laser arm, 4 patients (20%) experienced complications according to the modified Clavien classification system versus 5 (25%) in the laparoscopic group (P > .99). Conclusion: Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay

Holmium laser enucleation versus laparoscopic simple prostatectomy for large adenomas.

OBJECTIVE: The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy. MATERIALS AND METHODS: We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n=20) with laser enucleation of the prostate (n=20) for large adenomas (>100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test. RESULTS: There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P=.0008) and hospital stay (P<.0001) were significantly less in the laser group. Both groups showed a statistically significant improvement in functional variables at 3 months post operatively. The cost utility analysis for Holmium per case was 2589 euros versus 4706 per laparoscopic case. In the laser arm, 4 patients (20%) experienced complications according to the modified Clavien classification system versus 5 (25%) in the laparoscopic group (P>.99). CONCLUSION: Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay.

A novel method of bladder neck imbrication to improve early urinary continence following robotic-assisted radical prostatectomy.

Early return of continence forms an important component of quality of life for patients after robotic-assisted radical prostatectomy (RALP). Here we describe the steps of bladder neck imbrication and vesico-urethral anastomosis improving early continence after RALP. Between April 2008 and July 2009, 202 consecutive patients underwent RALP for clinically localised prostate cancer in a tertiary referral centre by a single surgeon. One hundred and thirty-two (65 %) of these patients agreed to participate in the study. Prior to November 2008, 51 patients underwent standard RALP as described by Patel et al. From November 2008, 81 patients underwent a novel method of bladder neck imbrication. The robotic urethro-vesical anastomosis commences on the posterior wall of the urethra and proceeds anteriorly. In our technique the anastomosis is halted with the suture arms fixed to the anterior abdominal wall. A new suture is used to perform a two-layer repair, anchoring proximally then continuing anteriorly to the level of the urethral stump, where it returns upon itself. The aim is to narrow the urethra to 16 Fr and tighten the second layer to create an imbrication effect. Posterior reconstruction was performed in all patients. Outcome measures were recorded prospectively using the Expanded Prostate Cancer Index Composite tool. Our technique shows significant improvement at all stages of follow-up in urinary summary and incontinence scores. Absolute continence rates increased from 8.2 to 20.5 %, 26.7 to 44.3 %, and 47.7 to 62.3 % at 1.5, 3 and 6 months, respectively. These results support the use of our technique in patients undergoing RALP.