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Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures.
J Urol. 2005 Oct; 174(4 Pt 1):1271-5; discussion 1275.JU

Abstract

PURPOSE

We review our experience with endoscopic (totally) extraperitoneal radical prostatectomy (EERPE) as first line therapy for localized prostate cancer.

MATERIALS AND METHODS

A total of 700 consecutive patients underwent EERPE. Mean patient age was 63.4 years (range 42 to 77). Mean preoperative prostate specific antigen was 10.7 ng/ml (range 1.4 to 82). A total of 206 patients (29.4%) had a history of previous lower abdominal or pelvic surgery including inguinal hernioplasty with mesh placement and 43 patients (6.1%) had a history of prostatic intervention (transurethral resection of the prostate, high intensity focused ultrasound, Millin prostatectomy, radiotherapy). After preparation of the preperitoneal space the technique of EERPE duplicates the steps of classic open descending retropubic radical prostatectomy including a nerve sparing EERPE when indicated.

RESULTS

Mean operative time was 151 minutes (range 50 to 320). There was no conversion and the transfusion rate was 0.9% in 6. Four patients (0.6%) had intraoperative rectal injuries which were treated endoscopically with a 2-layer suture. A total of 14 patients (2%) required early and 3 patients (0.4%) required late postoperative reintervention. Pathological stage was pT2a in 89 patients (12.7%), pT2b in 54 (7.7%), pT2c in 245 (35%), pT3a in 229 (32.7%), pT3b in 79 (11.2%) and pT4 in 4 patients (0.6%). Positive surgical margins were found in 10.8% (42 of 388) of patients with a pT2 tumor and in 31.2% (96 of 308) of patients with a pT3 tumor. Pelvic lymph node dissection was performed in 266 patients (38%), of whom 14 (5.3%) were found to have lymph node involvement. Mean catheterization time was 6.2 days. Six months after surgery 83.8% of the patients were completely continent, 10.4% needed 1 to 2 pads daily and 5.8% of patients needed more than 2 pads daily. Of all patients who underwent nerve sparing procedures, 100 patients had a postoperative followup of 6 months. Of the 66 patients with the unilateral nerve sparing approach 8 (12.1%) had erections sufficient for intercourse and 16 of 34 patients (47.1%) with the bilateral nerve sparing procedure had erections sufficient for intercourse with or without the help of phosphodiesterase type 5 inhibitors.

CONCLUSIONS

The results of this series are promising. Perioperative morbidity is low, and short-term oncological and functional results are favorable. Although the followup is too short to draw definite conclusions, it is obvious that a nerve sparing approach in EERPE is feasible and reproducible. Our data demonstrate that EERPE can be performed with equal efficacy and results compared with laparoscopic transperitoneal radical prostatectomy, while providing the ease and safety of a totally extraperitoneal approach, completely avoiding intraperitoneal complications.

Authors+Show Affiliations

Department of Urology, University of Leipzig, Leipzig, Germany. stolj@medizin.uni-leipzig.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16145391

Citation

Stolzenburg, Jens-Uwe, et al. "Endoscopic Extraperitoneal Radical Prostatectomy: Oncological and Functional Results After 700 Procedures." The Journal of Urology, vol. 174, no. 4 Pt 1, 2005, pp. 1271-5; discussion 1275.
Stolzenburg JU, Rabenalt R, DO M, et al. Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. J Urol. 2005;174(4 Pt 1):1271-5; discussion 1275.
Stolzenburg, J. U., Rabenalt, R., DO, M., Ho, K., Dorschner, W., Waldkirch, E., Jonas, U., Schütz, A., Horn, L., & Truss, M. C. (2005). Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. The Journal of Urology, 174(4 Pt 1), 1271-5; discussion 1275.
Stolzenburg JU, et al. Endoscopic Extraperitoneal Radical Prostatectomy: Oncological and Functional Results After 700 Procedures. J Urol. 2005;174(4 Pt 1):1271-5; discussion 1275. PubMed PMID: 16145391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. AU - Stolzenburg,Jens-Uwe, AU - Rabenalt,Robert, AU - DO,Minh, AU - Ho,Kossen, AU - Dorschner,Wolfgang, AU - Waldkirch,Eginhard, AU - Jonas,Udo, AU - Schütz,Alexander, AU - Horn,Lars, AU - Truss,Michael C, PY - 2005/9/8/pubmed PY - 2005/10/20/medline PY - 2005/9/8/entrez SP - 1271-5; discussion 1275 JF - The Journal of urology JO - J Urol VL - 174 IS - 4 Pt 1 N2 - PURPOSE: We review our experience with endoscopic (totally) extraperitoneal radical prostatectomy (EERPE) as first line therapy for localized prostate cancer. MATERIALS AND METHODS: A total of 700 consecutive patients underwent EERPE. Mean patient age was 63.4 years (range 42 to 77). Mean preoperative prostate specific antigen was 10.7 ng/ml (range 1.4 to 82). A total of 206 patients (29.4%) had a history of previous lower abdominal or pelvic surgery including inguinal hernioplasty with mesh placement and 43 patients (6.1%) had a history of prostatic intervention (transurethral resection of the prostate, high intensity focused ultrasound, Millin prostatectomy, radiotherapy). After preparation of the preperitoneal space the technique of EERPE duplicates the steps of classic open descending retropubic radical prostatectomy including a nerve sparing EERPE when indicated. RESULTS: Mean operative time was 151 minutes (range 50 to 320). There was no conversion and the transfusion rate was 0.9% in 6. Four patients (0.6%) had intraoperative rectal injuries which were treated endoscopically with a 2-layer suture. A total of 14 patients (2%) required early and 3 patients (0.4%) required late postoperative reintervention. Pathological stage was pT2a in 89 patients (12.7%), pT2b in 54 (7.7%), pT2c in 245 (35%), pT3a in 229 (32.7%), pT3b in 79 (11.2%) and pT4 in 4 patients (0.6%). Positive surgical margins were found in 10.8% (42 of 388) of patients with a pT2 tumor and in 31.2% (96 of 308) of patients with a pT3 tumor. Pelvic lymph node dissection was performed in 266 patients (38%), of whom 14 (5.3%) were found to have lymph node involvement. Mean catheterization time was 6.2 days. Six months after surgery 83.8% of the patients were completely continent, 10.4% needed 1 to 2 pads daily and 5.8% of patients needed more than 2 pads daily. Of all patients who underwent nerve sparing procedures, 100 patients had a postoperative followup of 6 months. Of the 66 patients with the unilateral nerve sparing approach 8 (12.1%) had erections sufficient for intercourse and 16 of 34 patients (47.1%) with the bilateral nerve sparing procedure had erections sufficient for intercourse with or without the help of phosphodiesterase type 5 inhibitors. CONCLUSIONS: The results of this series are promising. Perioperative morbidity is low, and short-term oncological and functional results are favorable. Although the followup is too short to draw definite conclusions, it is obvious that a nerve sparing approach in EERPE is feasible and reproducible. Our data demonstrate that EERPE can be performed with equal efficacy and results compared with laparoscopic transperitoneal radical prostatectomy, while providing the ease and safety of a totally extraperitoneal approach, completely avoiding intraperitoneal complications. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/16145391/Endoscopic_extraperitoneal_radical_prostatectomy:_oncological_and_functional_results_after_700_procedures_ DB - PRIME DP - Unbound Medicine ER -