最长尿道长度保存对腹腔镜前列腺癌根治术后尽快恢复尿控的意义研究

目的:研究最长尿道长度保存(maximal urethral length preservation,MULP)对腹腔镜前列腺癌根治术后尽快恢复尿控的临床意义。方法:回顾性分析我院2013年2月~2015年3月80例行腹腔镜前列腺癌根治术的临床资料,随访至2016年3月。其中40例进行MULP腹腔镜前列腺癌根治术患者为治疗组,另外40例非行MULP腹腔镜前列腺癌根治术患者为对照组,在手术前两组患者年龄、平均BMI、既往史(糖尿病)、术前NHT、前列腺体积、术前前列腺特异性抗原(PSA)、术前Gleason评分、术前病理T分期均无统计学意义(P0.05)。比较治疗组与对照组手术时间、切缘阳性率、前列腺尖部切缘阳性率、术后PSA(ng/ml)、术后Gleason评分、并发症率及两组患者术后1、3、6、12个月尿控恢复情况、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-QSF)评分情况。结果:两组患者手术都成功完成,两组术后3、6、12个月并发症发生率、切缘阳性率、前列腺尖部切缘阳性率及PSA0.2ng/ml的比率差异均无统计学意义(P0.05)。两组术后1、3个月尿控恢复人数和ICIQ-SF评分情况差异均有统计学意义(P0.05);术后6、12个月的尿控恢复人数和ICI-Q-SF评分情况差异均无统计学意义(P0.05)。结论:行MULP的腹腔镜前列腺癌根治术有利于术后早期尽快恢复尿控,且不增加切缘阳性率。     

腹腔镜筋膜内与筋膜外前列腺癌根治术近期疗效比较

目的比较经腹膜外途径腹腔镜筋膜内前列腺癌根治术相对于筋膜外前列腺癌根治术在近期治疗效果方面的优劣,评价其临床价值。方法回顾性分析接受同一术者施行的经腹膜外途径腹腔镜前列腺癌根治术治疗的39例患者的临床资料,其中行腹腔镜筋膜内前列腺癌根治术(筋膜内组)20例,筋膜外前列腺癌根治术(筋膜外组)19例。结果 39例手术均获得成功,两组患者在年龄、血清前列腺特异性抗原(PSA)值、前列腺大小、Gleason评分、手术时间、术中出血量、术后进食、住院总费用、术后并发症及切缘阳性率均无明显差异。筋膜内组患者在术后住院时间、术后3月尿控恢复情况及术后6、12月性功能恢复情况方面明显优于筋膜外组患者,差异有统计学意义(P0.05),而术后6月、12月尿控恢复情况两组患者差异无统计学意义(P0.05)。结论腹腔镜下筋膜内前列腺癌根治术在手术时间、术中出血量、切缘阳性率等方面可取得与筋膜外前列腺癌根治术相当的效果,对于较年轻、肿瘤分期为cT1~cT2术前性功能正常的患者,腹腔镜下筋膜内前列腺癌根治性切除术是一种值得推荐的手术方式。     

腹腔镜前列腺癌根治术治疗高危前列腺癌的临床体会

目的：探讨腹腔镜前列腺癌根治术在高危前列腺癌治疗中的价值。方法回顾性分析2012年3月～2014年11月本院腹腔镜前列腺癌根治术治疗26例高危前列腺癌的临床资料。患者平均年龄65．2岁,术前检查单独PSA≥20ng／mL者9例;兼具PSA≥20ng／mL并Gleason评分≥8分者17例;术前诊断T3 b和T4期各1例。3例患者因前列腺体积过大术前分别行3～6个月新辅助内分泌治疗。手术方式均采用经腹膜外路径腹腔镜前列腺癌根治术,同时行盆腔淋巴结清扫。结果26例手术均获成功,平均手术时间152min,平均出血量85mL,无输血病例。所有患者均于术后两周拔除导尿管,8例拔管后尿失禁,经盆底训练后于1周至3个月恢复控尿。术后病理T2a～T2b,Gleason评分≤7分者10例;T2c～T4,Gleason评分≥8分者16例。术中清扫淋巴结数目平均5．5个,淋巴结阳性3例;切缘阳性4例,术后控尿恢复后予局部放射治疗。19例获访3～30个月,所有患者均控尿良好,PSA≤0．2ng／mL。结论对高危前列腺癌患者采用以根治性前列腺癌切除术为核心的综合治疗策略安全有效,可使患者获益。     

腹腔镜筋膜内前列腺癌根治性切除术对尿控恢复的影响及相关因素分析

目的:通过总结我院腹腔镜筋膜内前列腺癌根治性切除术的方法及患者术后尿控恢复的随访记录,对影响尿控恢复的相关因素进行分析。方法:2009年9月至2012年11月共为128例患者行腹腔镜筋膜内前列腺癌根治性切除术,患者43~78岁,平均(57.0±11.4)岁,术前血PSA 4.1~18.8 ng/ml,平均(9.9±6.1)ng/ml;临床分期T185例、T243例;活检组织Gleason评分:5分13例、6分38例、7分77例,术中不打开盆底筋膜,自膀胱颈口1点及11点位置纵行切开前列腺筋膜,紧贴前列腺包膜分离前列腺前面、两侧、尖部,最大限度保留盆底神经及肌肉组织,术后随访患者尿控变化12个月。结果:128例手术均顺利完成,无中转筋膜外前列腺癌根治性切除术,手术时间45~118 min,平均(84.0±24.6)min;术中出血量15~220 ml,平均(140.0±52.1)ml;无输血,留置尿管7~15 d,平均(11.0±3.8)d。术后随访12个月,完全尿控96例(75.0%),轻微尿失禁28例(21.9%),中度尿失禁4例(3.1%),无重度及完全尿失禁病例。结论:腹腔镜筋膜内前列腺癌根治性切除术最大限度地保留了盆底肌肉、神经组织,使术后尿控得到更好的恢复,值得推广应用。     

保留部分近端前列腺部尿道的腹腔镜前列腺癌根治术及其临床观察

目的探讨保留部分近端前列腺部尿道的腹腔镜前列腺癌根治术的手术方法,分析该术式的安全性、可行性及其对早期尿控恢复的作用。方法对31例保留部分近端前列腺部尿道的腹腔镜前列腺癌根治术(A组)和26例非保留部分近端前列腺部尿道的腹腔镜前列腺癌根治术(B组)的患者的临床资料进行回顾性分析:观察比较两组手术时间、术中出血量、切缘阳性率、尿控、围术期并发症。结果两组手术时间、术中出血量、切缘阳性率、围术期并发症无显著性差异。拔除导尿管后2周、1个月、3个月时两组尿控有显著性差异(P0.05)。结论保留近端前列腺部尿道的腹腔镜前列腺癌根治术是一种安全、可行的手术方法,对术后早期尿控的恢复起到了积极的促进作用。     

腹腔镜根治性前列腺切除术后切缘阳性的相关因素分析

目的：分析腹腔镜根治性前列腺切除术后切缘阳性的相关因素。方法：2004年1月～2010年12月,我院完成腹腔镜根治性前列腺切除术188例,平均年龄72岁。患者根治术前均经病理检查确诊为前列腺癌,未发现肿瘤转移征象。采用单因素分析研究各参数对切缘情况的影响,采用多因素Logistic回归分析确定切缘阳性的独立危险因素。结果：除2例患者中转开放手术外,其余患者均在腹腔镜下完成手术。平均手术时间246min,平均出血量309ml。术后病理回报切缘阳性76例,占40．5％。单因素分析提示切缘阳性组与切缘阴性组穿刺Gleason评分、穿刺阳性针数、根治病理Gleason评分、病理分期差异有统计学意义（P〈0．05）。多因素Logistic回归分析显示根治标本Gleason评分、病理分期是切缘阳性的独立相关因素。根治标本Gleason评分8分相对于Gleason评分6分患者切缘阳性风险增高17．1倍（比值比为17．131,95％置信区间为5．237～56．037,P〈0．001）,病理分期T1期相对于T2期患者切缘阳性风险增高9．0倍（比值比为8．970,95％置信区间为4．128～19．493,P〈0．001）。结论：根治标本Gleason评分、病理分期是腹腔镜根治性前列腺切除术后切缘阳性独立危险因素。根治标本Gleason评分为8分、病理分期为T3期患者的切缘阳性率显著增高。     

前列腺体积对腹腔镜下前列腺根治性切除术后组织病理学预后的影响

目的 探讨术前前列腺体积对于腹腔镜下前列腺根治性切除术后组织病理学预后的影响. 方法 回顾性分析2006年10月至2011年3月216例经前列腺穿刺括检诊断为前列腺腺癌并行腹腔镜下前列腺根治性切除术患者的资料,根据术前经直肠前列腺超声检查测定的前列腺体积将患者分为较小前列腺组( ＜30 ml)103例(47.7％)、中等前列腺组(30 ～60 ml)71例(32.9％)和较大前列腺组( ＞60ml)42例(19.4％).术前资料包括患者确诊时年龄、体质指数(BMI)、PSA、前列腺体积、穿刺阳性百分数、临床分期、穿刺Gleason评分等,术后组织病理学参数包括患者大体病理Gleason评分、是否存在术后病理升级、病理分期、切缘情况等.比较3组患者临床资料和术后组织病理学参数并进行统计学分析. 结果 3组患者术前PSA值随前列腺体积增大而升高,组间差异有统计学意义(P＜0.01),年龄、BMI、穿刺Gleason评分、穿刺阳性百分数及临床分期等对比较差异均无统计学意义(P＞0.05).小体积前列腺与较差的组织病理学预后相关,小体积前列腺痛患者术后Gleason评分较高(P =0.034),更容易出现大体病理升级现象(P=0.037),术后病理分期晚(P=0.025),特别是包膜侵犯的发生率增高(P =0.013).前列腺体积由小至大3组标本切缘阳性率分别为35.0％、33.8％和19.0％,差异无统计学意义(P =0.152). 结论 前列腺体积较小的前列腺癌患者行腹腔镜下前列腺根治性切除术后的组织病理学预后较差,肿瘤恶性程度高、病理分期晚,在临床工作中应予以重视.     

腹腔镜前列腺癌根治术后切缘阳性的影响因素对比分析

目的:对比分析腹腔镜前列腺癌根治术后切缘阳性的相关影响因素。方法:选取2012年9月~2015年9月于我院住院部就诊的经穿刺病理诊断为前列腺癌并行腹腔镜前列腺癌根治术的108例患者,回顾性分析术前血清PSA、穿刺后Gleason评分、病理T分期与术后切缘阳性的相关性。结果:不同术前血清PSA10ng/ml、10~20ng/ml与20ng/ml三组差异无统计学意义(χ~2=3.69,P=0.21);不同穿刺后Gleason评分,≤6、7与≥8三组差异无统计学意义(χ~2=7.8,P=0.063);而不同病理T分期,T_(1a)~T_(2a)、T_(2b)与T_(2c)~T_(3b)三组差异有统计学意义(χ~2=6.371,P=0.041)。同时通过对术前血清PSA、穿刺后Gleason评分、病理T_2及T_3分期这4个变量进行Logistic回归分析,得出结果无论是总体部位还是前列腺体部,病理T_3期都是影响术后切缘阳性的一个重要因素。结论:术前血清PSA值及穿刺后Gleason评分与前列腺癌术后切缘阳性无相关性,穿刺病理T分期对前列腺癌根治术后切缘阳性的差异有统计学意义,并且病理T_3期是影响术后切缘阳性的一个独立因素。     

经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的影响因素分析

目的探讨经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的相关影响因素。方法 2009年9月至2014年5月,采用经腹腔途径行腹腔镜下前列腺癌根治术61例。患者年龄56~74岁,平均71岁。术前均经直肠超声引导下穿刺病理证实前列腺癌诊断。通过回顾性研究了解术前血清前列腺特异性抗原(PSA)、穿刺后Gleason评分、穿刺针数阳性百分率,术前TNM分期对手术切缘阳性的影响。结果61例前列腺癌患者术后切缘阳性率19.7%(12/61),病理分期与手术切缘阳性成正相关(γ=0.311,P=0.001),且对手术切缘阳性有统计学意义(χ~2=16.32,P=0.001);对于手术切缘阳性率,术前血清PSA20ng/ml组与血清PSA≥20ng/ml组比较,差异有统计学意义(χ~2=7.32,P=0.007);穿刺后Gleason评分7分组与Gleason评分≥7分组差异无统计学意义了(χ~2=1.43,P=0.23);穿刺针数阳性百分率,50%组与≥50%组差异有统计学意义(χ~2=4.32,P=0.017)。结论穿刺后TNM分期,血清PSA水平,穿刺阳性百分率的差异对手术切缘阳性有统计学意义。前列腺癌穿刺标本Gleason评分与术后病理切缘之间无相关性。     

经腹膜外腹腔镜前列腺癌根治术329例报告

目的:回顾分析329例经腹膜外腹腔镜前列腺癌根治术的手术方法和疗效。方法:2005年3月～2010年3月经腹膜外腹腔镜前列腺癌根治术329例,中位年龄67岁,初始前列腺特异性抗原中位数为17.35μg/L,活检Gleason评分中位数为7。结果:329例手术均成功完成,无中转开放手术。膀胱尿道吻合时间中位数为13min,手术时间中位数为90min,术中失血量中位数为75ml,术后尿管留置时间中位数为6d。整体切缘阳性率为16.7%,与病理分期和Gleason评分具有相关性(P<0.001)。术后1年内,年轻患者的尿控能力恢复较快,而且性功能恢复较好。术后随访时间中位数为27(14～72)个月,89例出现生化复发;多因素分析显示初始PSA值、切缘阳性率、病理分期和Gleason评分是无生化复发生存的独立预后因素。术前新辅助激素治疗对病理Gl-eason评分(P<0.001)和手术切缘阳性率(P=0.027)有显著影响,但对生化复发没有显著影响(P=0.202)。结论:经腹膜外腹腔镜前列腺癌根治术是局限性前列腺癌安全有效的微创外科治疗方法,值得临床推广。     

Is a cystogram necessary after robot-assisted radical prostatectomy?

PURPOSE: Robot-assisted radical prostatectomy has become an acceptable option for the treatment of clinically localized prostate cancer. The role of cystography in robot-assisted radical prostatectomy was evaluated prospectively. METHODS AND MATERIALS: A total of 80 consecutive patients who underwent robot-assisted radical prostatectomy with an intraperitoneal approach were evaluated. There were 40 patients (group 1/surgeon A) who received a routine postoperative cystogram before Foley catheter removal. An additional 40 patients (group 2/surgeon B) had their catheters removed without radiographic imaging. Patient demographics, intraoperative data, postoperative data, and complications were recorded prospectively. RESULTS: The 2 groups were similar in age, Gleason score, and history of previous urethral/bladder neck surgery. Univariate analysis showed no statistical difference among case duration, estimated blood loss, need for bladder neck reconstruction, presence of visible anastomotic leak, or use of pelvic drains. Anastomosis time was the only variable that reached statistical significance. Mean catheter duration (11 days) was similar between the 2 groups. There were 3 patients from group 1 who had an anastomotic leak identified on a cystogram. In group 2, 1 patient had a persistent mild leak based on a cystogram obtained for urinary symptoms. No patient in either group had urinary retention, urinary tract infection, renal failure, or bladder neck contracture develop. The degree of postoperative urinary incontinence was similar between groups. CONCLUSION: Foley catheter removal on postoperative days 8-10 after robot-assisted radical prostatectomy without routine cystography appears safe.     

A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience

PURPOSE: We compared a single institution experience with radical prostatectomy using a pure laparoscopic technique vs a robotically assisted technique with regard to preoperative, intraoperative or postoperative parameters. MATERIALS AND METHODS: From May 2003 to May 2005 we reviewed 133 consecutive patients who underwent extraperitoneal robot assisted radical prostatectomy and compared them to 133 match-paired patients treated with a pure extraperitoneal laparoscopic approach. The patients were matched for age, body mass index, previous abdominopelvic surgery, American Society of Anesthesiologists score, prostate specific antigen, pathological stage and Gleason score. Preoperative, perioperative and postoperative data, including complications and oncological results, were analyzed between the 2 groups. RESULTS: The 2 groups were statistically similar with respect to age, body mass index, prostate specific antigen, Gleason score and clinical stage. No statistical differences were observed regarding operative time, estimated blood loss, hospital stay or bladder catheterization between the 2 groups. The transfusion rate was 3% and 9.8% for laparoscopic radical prostatectomy and robotic assisted laparoscopic prostatectomy, respectively (p = 0.03). Conversion from robotic assisted laparoscopic prostatectomy to laparoscopic radical prostatectomy was necessary in 4 cases. None of the laparoscopic radical prostatectomy cases required conversion to an open technique. The percentage of major complications was 6.0% vs 6.8%, respectively (p = 0.80). The overall positive margin rate was 15.8% vs 19.5% for laparoscopic radical prostatectomy and robotic assisted laparoscopic prostatectomy, respectively (p = 0.43). CONCLUSIONS: We demonstrated that the laparoscopic extraperitoneal radical prostatectomy is equivalent to the robotic assisted laparoscopic prostatectomy in the hands of skilled laparoscopic urological surgeons at our institution with respect to operative time, operative blood loss, hospital stay, length of bladder catheterization and positive margin rate.     

Early removal of the catheter after laparoscopic radical prostatectomy

PURPOSE: We prospectively tested the safety of routine removal of the catheter as early as 2 to 4 days after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between March 1998 and March 2001, 228 patients underwent laparoscopic radical prostatectomy for clinically organ confined prostate cancer. The last 113 consecutive patients were included in a prospective study according to gravitational cystography performed 2 to 4 days postoperatively. If no leak was seen the catheter was removed. If a leak was apparent the catheter was left indwelling for another 6 days and cystography was repeated. RESULTS: Cystography 2 to 4 days postoperatively showed an anastomosis without a leak in 96 (84.9%) patients who subsequently had the catheters removed. There were 28 patients who had the catheter removed on postoperative day 2, 28 day 3 and 40 day 4. In 17 (15.1%) patients an anastomotic leak was observed, and the catheter was not removed at that time. Of the 96 patients in whom the catheter was removed early 10 (10.4%) had urinary retention that necessitated re-catheterization. This procedure was performed without the need for cystoscopy. After the catheter was removed all patients were able to void 24 hours later. Median followup was 7 months (range 1 to 15) and showed continence rates greater than 93%. No anastomotic stricture, pelvic abscess or urinoma developed in any patient. CONCLUSIONS: Patients who undergo laparoscopic radical prostatectomy can have the catheter safely removed 2 to 4 days postoperatively without a higher risk of incontinence, stricture or leak related problems.     

腹膜外途径腹腔镜下根治性前列腺切除术切缘阳性的影响因素

目的探讨经腹膜外途径腹腔镜下根治性前列腺切除术后切缘阳性的影响因素。方法回顾性分析我院2010年1月至2018年12月99例行腹膜外途径腹腔镜下根治性前列腺切除术患者的临床资料。年龄51~79岁,平均(65.37±6.07)岁;前列腺特异抗原(PSA)2.80~79.50ng/mL,平均(16.84±12.28)ng/mL。分析术后病理切缘阳性的特征。按年龄、体质指数、术前PSA水平、穿刺针数阳性百分率、穿刺至手术时间、穿刺病理Gleason评分、临床T分期、前列腺癌危险分度、术后病理Gleason评分、术后T分期、腹盆腔手术史等进行分组,分析各组切缘阳性率的差异。采用χ^2检验进行单因素分析,有统计学差异的变量进入多因素Logistic回归分析,评价临床及病理相关资料与切缘阳性的关系。结果本组99例患者均在腹腔镜下顺利完成,无1例中转开放,手术时间平均(199.66±66.01)min,术中出血量平均(152.02±140.28)mL。术后病理证实均为前列腺癌,术后病理切缘阳性26例(26.3%)。将各危险因素分组后进行单因素分析,结果显示不同穿刺针数阳性百分率(P=0.047)、穿刺病理Gleason评分(P=0.023)、术后病理Gleason评分(P=0.007)、术后T分期(P=0.004)与切缘阳性存在相关性(P<0.05),而年龄(P=0.134)、体质指数(P=0.838)、术前PSA水平(P=0.299)、穿刺至手术时间(P=1.000)、临床T分期(P=0.821)、前列腺癌危险分度(P=0.903)、腹盆腔手术史(P=0.607)与切缘阳性均无相关性(P>0.05)。将单因素分析差异有统计学意义的指标及术前PSA、临床分期进行多因素分析,结果显示仅术后T分期(P=0.011)是切缘阳性的独立危险因素。结论穿刺针数阳性百分率、穿刺病理Gleason评分、术后病理Gleason评分、术后T分期与切缘阳性存在相关性,其中穿刺针数阳性百分率、穿刺病理Gleason评分及术后T分期越高,切缘阳性率越高。术后T分期是经腹膜外途径腹腔镜下根治性前列腺切除术后切缘阳性的独立危险因素。     

Impact of body mass index on outcomes after robot assisted radical prostatectomy

In this study we evaluated the impact of body mass index (BMI) on operative and perioperative parameters and surgical margin rates, in patients who underwent robotic assisted radical prostatectomy (RARP).We retrospectively reviewed 140 consecutive RARPs performed by the same surgical team. Patients were stratified based on BMI into two categories: Group I: non-obese (91 patients) and Group II: obese (49 patients). Intraoperative parameters evaluated were: total operative time, estimated blood loss (EBL), intraoperative complications, status of nerve sparing and pelvic lymph node dissection. Postoperative parameters evaluated included positive surgical margin rate, pathological Gleason score and pathological stage, final tumor volume, length of stay (LOS), and postoperative complications. The two groups were statistically comparable for age, PSA, Gleason scores and clinical stages. Mean operative time was greater in the obese group at 300.5 min versus 247.3 min in the non-obese group. Mean EBL in obese patients and non-obese patients were 396.2 and 292.8 ml, respectively. Positive surgical margin rate was 26.5% in obese and 13.1% in non-obese patients. Robotic assisted radical prostatectomy in obese patients is a feasible procedure with acceptable perioperative outcomes and complications. In our study, obesity significantly but negatively affected operative and postoperative outcomes. Moreover, obesity was associated with higher grade tumors and higher incidence of positive surgical margins. Consequently, caution is advised in performing RARP in the obese patient in the early part of a learning curve.     

前列腺癌根治术后tPSA异常的影响因素

目的分析前列腺癌根治术后tPSA异常的影响因素,为前列腺癌患者个体化后续治疗提供依据。方法回顾性分析2004年1月至2013年10月在广西医科大学第一附属医院及附属肿瘤医院行前列腺癌根治术的72例前列腺癌患者的临床资料。单因素分析研究各参数对根治术后1个月tPSA异常的影响,多因素Logistic回归分析影响根治术后tPSA异常的独立因素。结果单因素分析显示年龄、前列腺体积、直肠指检、影像学表现、术前Gleason评分及临床分期对评估术后tPSA值异常无统计学意义（P〉0.05）。新辅助治疗、术前tPSA水平、病理分期、术后Gleason评分、淋巴结转移及切缘情况对评估术后tPSA值异常有统计学意义（P〈0.05）。多因素分析显示术后Gleason评分、淋巴结转移及切缘情况是术后tPSA异常的独立影响因素。结论术后Gleason评分、淋巴结转移、切缘情况是影响前列腺根治术后患者tPSA异常的独立因素。     

Laparoscopic radical prostatectomy: perioperative complications in an initial and consecutive series of 80 cases

OBJECTIVES: We retrospectively evaluated the intraoperative and early postoperative complications of the initial experience with the first 80 laparoscopic radical prostatectomies performed at our institution. METHODS: Between January 17, 2001 and July 24, 2002, 80 patients between 53 and 78 years old (mean age 63.8) with clinically localized prostate cancer underwent laparoscopic radical prostatectomy with the Montsouris technique. A total of 24 (30%) staging pelvic lymphadenectomy were performed. The inpatient and outpatient medical records as well as all complications were reviewed. RESULTS: The pathological tumor stage revealed 18 pT2a (22.5%), 29 pT2b (36.25%), 21 pT3a (26.25%), 10 pT3b (12.5%), 1 pT4 (1.25%), 1 pT4 N1 (1.25%). No conversion was necessary in all cases. Mean operative time was 218 minutes (range 150-420) overall, mean blood loss was 376 ml (range 50-1000) and the mean postoperative hospital stay was 4.5 days (range 3-9). The mean and the median duration of bladder catheterization were respectively 11 and 10 days (range 7-23). Injury to the epigastric vessels was detected intraoperatively in 5 cases (6.25%) with immediate hemostasis achieved. There was 1 death (1.25%) 35 days after a cerebrovascular accident occurred on postoperative day 3. We observed 1 (1.25%) postoperative ileus, hemoperitoneum in 5 cases (6.25%), 2 (2.5%) acute urinary retentions, 6 (7.5%) anastomotic leakages, 1 (1.25%) anastomotic stricture, 1 (1.25%) hydrocele and 2 (2.5%) urinary tract infections. CONCLUSIONS: In our initial experience laparoscopic radical prostatectomy was performed with no complications in 77.5% of patients. We observed major and minor complications respectively in 16.25% and 6.25% of the patients. Our series provides evidence that the laparoscopic approach is feasible and associated with acceptable perioperative morbidity.     

The impact of neoadjuvant hormonal therapy on the outcome of laparoscopic radical prostatectomy: a matched pair analysis

PURPOSE: We evaluated the effect of androgen ablation treatment on laparoscopic radical prostatectomy operative and postoperative parameters. MATERIALS AND METHODS: A total of 50 patients (group 1) on neoadjuvant androgen deprivation, followed by laparoscopic radical prostatectomy, were compared to 50 (group 2) without any treatment who were matched for prostate volume, laparoscopic pelvic lymphadenectomy, nerve sparing procedure, surgical access type and pathological stage. We analyzed operative time, blood loss, intraoperative and postoperative complications, catheter time, procedure difficulty as scored by the surgeon and surgical margin status. RESULTS: There was no significant difference between the neoadjuvant and nonneoadjuvant groups with respect to mean operative time +/- SD (228.6 +/- 62.9 vs 219.4 +/- 65.1 minutes), mean blood loss (667.6.1 +/- 217.1 vs 729.8 +/- 285.1 ml) and median catheter time (7 vs 7.5 days). We also found no difference related to the complication rate. Ten of 50 prostate dissections (20%) in group 1 were classified as difficult, whereas in group 2 only 4 of 50 (8%) were scored as difficult (p = 0.084). The positive surgical margin rates did not differ. CONCLUSIONS: There was no significant difference with respect to operative or postoperative parameters in patients undergoing neoadjuvant androgen ablation therapy compared to controls. At centers where there is experience laparoscopic radical prostatectomy can be safely performed in patients who have undergone neoadjuvant hormonal therapy.