Prostate‐sparing cystectomy: long‐term oncological results

OBJECTIVE

To analyse the oncological outcome of prostate‐sparing cystectomy (PSC).

PATIENTS AND METHODS

Between 1994 and 2006, 63 men were treated with PSC after meeting the inclusion criteria (no tumour at the bladder neck, no prostate cancer). The results were compared with patients who had a standard cystoprostatectomy (SC) during the same study period, after matching for clinical and pathological characteristics.

RESULTS

The 3‐ and 5‐year disease‐specific survival rates were 77% and 66% in the PSC group, and 68% and 64% in the SC group (log‐rank, P = 0.6). The local recurrence rate was 7.9% and 16% for the PSC and the SC groups, respectively, and the respective distant recurrence rate was 29% and 33%. Subsequent prostate cancer was detected in 3% in the PSC group. None of these patients died from prostate cancer. In the SC group the final pathology showed that 18% had prostate cancer.

CONCLUSION

Local recurrences were not diagnosed more often in the PSC than the SC group. The outcomes of both procedures are comparable with contemporary cystoprostatectomy series. We consider this procedure oncologically safe and offer this to selected patients. However, selection is the key to success, and our results should further be corroborated by the experience of others.     

The use of sling vs sphincter in post‐prostatectomy urinary incontinence

The artificial urinary sphincter (AUS) is considered the ‘gold standard’ in post‐prostatectomy urinary incontinence. However, in recent years, male slings have gained much popularity due to the ease of surgery, good functional results and low complications rates. This review systematically shows the evidence for the different sling systems, describes the working mechanism, and compares their efficacy against that of the AUS. Furthermore subgroups of patients are defined who are not suited to undergo sling surgery.     

Long‐term outcome of ureterosigmoidostomy: an analysis of patients with >10 years of follow‐up

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To examine our long‐term experience with ureterosigmoidostomy (USS) to evaluate its potential applicability in the treatment of benign and malignant conditions of the urinary bladder, as USS has been largely disregarded recently, secondary to concerns of long‐term complications, but has had a resurgence of interest due to its potential applicability to newer minimally invasive surgical techniques.

PATIENTS AND METHODS

We identified 51 patients who had USS from 1956 to 2006 at our institution and with >10 years of follow‐up. The patients were followed retrospectively by a chart review. Patient data were analysed in a multifaceted fashion, paying particular attention to metabolic abnormalities, early (≤30 days) and late (>30 days) complication rates, continence rates, imaging changes, and the rate of repeat surgical intervention.

RESULTS

The median (range) follow‐up was 15.7 (10.0–45.4) years and the median age at surgery was 58.8 (0.4–79.0) years; 40 (79%) patients had the procedure for malignancy and 11 (22%) for benign disease. Six patients (12%) had at least one early complication, including one wound dehiscence and one pulmonary embolus. In all, 22 patients (43%) had at least one late complication, with anastomotic stricture being the most common (11/51, 22%). This was followed by recurrent pyelonephritis in eight patients (16%), stones in five (10%), chronic renal insufficiency in three (6%) and severe intractable acidosis in two (4%). A repeat surgical intervention was required in 19 (37%) patients. In all, 94% (48) reported complete continence. No patient developed colonic malignancy during the course of this study.

CONCLUSIONS

USS is associated with long‐term complications. While this complication rate might not be acceptable for all patients, some might be willing to undergo the procedure as the primary method of urinary diversion. When designing newer minimally invasive techniques for the treatment of benign and malignant conditions of the bladder, consideration could be given to USS as a form of urinary diversion in highly selected patients.