Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy:A propensity score matched analysis

Objective:Placement of human placenta derived grafts during robotic-assisted radical prostatectomy(RARP)hastens the return of continence and potency.The long-term impact on the oncologic outcomes remains to be investigated.Our objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane(dHACM)at RARP compared to a matched cohort.Methods:In a referral centre,from August 2013 to October 2019,599 patients used dHACM in bilateral nerve-sparing RARP.We excluded patients with less than 12 months follow-up,simple prostatectomy,and unilateral nerve-sparing.Patients with dHACM(amnio group)were 529,and were propensity score matched 1:1 to 2465 patients without dHACM(non-amnio group)and a minimum follow-up of 36 months.At the time of RARP,dHACM was placed around the neurovascular bundle in the amnio group.Continuous and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test respectively.Outcomes measured were biochemical recurrence(BCR),adjuvant and salvage therapy rates.Results:Propensity score matching resulted in two groups of 444 patients.Cumulative incidence functions for BCR did not show a difference between the groups(p=0.3).Patients in the non-amnio group required salvage therapy more frequently than the amnio group,particularly after partial nerve-sparing RARP(6.3%vs.2.3%,p=0.001).Limitations are the absence of prospective randomization.Conclusion:The data suggest that using dHACM does not have a negative impact on BCR in patients.Outcomes of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts’impact on prostate cancer biology.

A systematic review of cytoreductive prostatectomy outcomes and complications in oligometastatic disease

Objective: To analyze outcomes and complications of cytoreductive prostatectomy (CRP) for oligometastatic prostate cancer (PCa) in order to elucidate its role in this space.Methods: We performed a systematic literature search using three databases (Medline, Scopus, and Web of Science). The primary endpoints were oncologic outcomes. The secondary endpoints were complication rates and functional results.Results: In all studies, overall survival was better or at least comparable variable in the groups with CRP compared to no local treatment. The greatest benefit from CRP in 5-year overall survival in one study was 67.4% for CRP versus 22.5% for no local treatment. Cancer-specific survival (CSS) showed the same trend. Several authors found significant benefits from CSS in the CRP group: from 79% vs. 46% to 100% vs. 61%. CRP was a predictor of better CSS (hazard ratio 0.264, p=0.004). Positive surgical margin rates differed widely from 28.6% to 100.0%. Urinary continence in CRP versus RP for localized PCa was significantly lower (57.4% vs. 90.8%, p<0.0001). Severe incontinence occurred seldom (2.5%-18.6%). Total complication rates after CRP differed widely, from 7.0% to 43.6%. Rates of grades 1 and 2 events prevailed. Patients on ADT alone also showed a considerable number of complications varying from 5.9% to 57.7%.Conclusion: CRP improves medium-term cancer control in patients with oligometastatic PCa. The morbidity and complication rates of this surgery are comparable with other approaches, but postoperative incontinence rate is higher compared with RP for localized disease.

Prevention of thromboembolic events after radical prostatectomy in patients with hereditary thrombophilia due to a factor V Leiden mutation by multidisciplinary coagulation management

Objective:To examine the perioperative impact of factor V Leiden mutation on thromboembolic events'risk in radical prostatectomy(RP)patients.With an incidence of about 5%,factor V Leiden mutation is the most common hereditary hypercoagulability among Caucasians and rarer in Asia.The increased risk of thromboembolic events is three-to seven-fold in heterozygous and to 80-fold in homozygous patients.Methods:Within our prospectively collected database,we analysed 33006 prostate cancer patients treated with RP between December 2001 and December 2020.Of those,patients with factor V Leiden mutation were identified.All patients received individualised recommendation of haemostaseologists for perioperative anticoagulation.Thromboembolic complications(deep vein thrombosis and pulmonary embolism)were assessed during hospital stay,as well as according to patient reported outcomes within the first 3 months after RP.Results:Overall,85(0.3%)patients with known factor V Leiden mutation were identified.Median age was 65(interquartile range:61-68)years.There was at least one thrombosis in 53(62.4%)patients and 31(36.5%)patients had at least one embolic event in their medical history before RP.Within all 85 patients with factor V Leiden mutation,we experienced no thromboembolic complications within the first 3 months after surgery.Conclusion:In our cohort of patients with factor V Leiden mutation,no thromboembolic events were observed after RP with an individualised perioperative coagulation management concept.This may reassure patients with this hereditary condition who are counselled for RP.

Dual innervation method to preserve erectile function following prostatectomy

Prostate cancer is the second most prevalent cancer in men.Robot-assisted radical prostatectomy(RARP)has altered the landscape of prostate cancer treatment.Despite the excellent oncological outcomes associated with RARP,the rate of erectile dysfunction(ED)remains high.Primary repair of disrupted cavernous nerves with interpositional nerve grafts has been described;however,the outcomes have been inconsistent.We hypothesize that this is attributed to Schwann cell atrophy and axonal regeneration limitations caused by long nerve grafts.We proposed the use of nerve transfer to support axonal regrowth via an inter-positional graft with additional donor axons.A cadaveric study was performed to evaluate the anatomical feasibility of a vastus lateralis nerve(VLN)transfer to the distal recipient cavernous nerve stump.The VLN is long with multiple branching patterns that allow tension-free coaptation of the cavernous nerve.We postulate that a dual innervation method using VLN nerve transfer together with interpositional nerve graft repair of the transacted cavernous nerves may improve the outcomes of ED post-RARP.

Intermediate-term oncological and functional outcomes in prostate cancer patients treated with perineal robot-assisted radical prostatectomy:A single center analysis

Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 months.Methods:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were selected.Baseline,intraoperative,pathological,and postoperative data were collected and then analyzed.Results:Thirty-seven p-RARP cases were included.Such patients presented mean age of 62 years and a mean Charlson comorbidity index of 4.Body mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical history.Mean prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,respectively.The median operative time was 242 min.The positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was observed.No patient with biochemical recurrence or distant metastasis was reported at 2 years of follow-up.Recovery of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.

Initial experience of laparoendoscopic single-site radical prostatectomy with a novel purpose-built robotic system

Objective This prospective single-arm clinical trial aimed to evaluated the feasibility and safety of the application of the SHURUI system(Beijing Surgerii Technology Co.,Ltd.,Beijing,China),a novel purpose-built robotic system,in single-port robotic radical prostatectomy.Methods Sixteen patients diagnosed with prostate cancer were prospectively enrolled in and underwent robotic radical prostatectomy from October 2021 to August 2022 by the SHURUI single-port robotic surgical system.The demographic and baseline data,surgical,oncological,and functional outcomes as well as follow-up data were recorded.Results The mean operative time was 226.3(standard deviation[SD]52.0)min,and the mean console time was 183.4(SD 48.3)min,with the mean estimated blood loss of 116.3(SD 90.0)mL.The mean length of postoperative hospital stay was 4.50(SD 0.97)days.Two patients had postoperative complications(Clavien-Dindo Grade II),and both patients improved after conservative treatment.All patients’postoperative prostate-specific antigen levels decreased to below 0.2 ng/mL 1 month after discharge.The mean prostate-specific antigen level further decreased to a mean of 0.0219(SD 0.0641)ng/mL 6 months after surgery.Thirty days postoperatively,12 out of 16 patients reported using no more than one urinary pad per day,and all patients reported satisfactory urinary control without the need for pads 6 months after surgery.Conclusion The SHURUI system is safe and feasible in performing radical prostatectomy via both transperitoneal and extraperitoneal approaches.Tumor control and urinary continence were satisfying for patients enrolled in.The next phase involves conducting a large-scale,multicenter randomized controlled trial to thoroughly assess the effectiveness and safety of the new technology in a broader population.

First 100 cases of transvesical single-port robotic radical prostatectomy

Objective:To describe the surgical technique and report the early outcomes of the transvesical(TV)approach to single-port(SP)robot-assisted radical prostatectomy.Methods:All procedures were performed at a single center by one surgeon.We identified the first 100 consecutive patients with clinically localized prostate cancer that underwent SP TV robot-assisted radical prostatectomy using the da Vinci SP robotic surgical system.Data were collected prospectively and analyzed with descriptive statistics.The primary outcomes assessed were postoperative urinary continence,rate of biochemical recurrence,and sexual function.Results:All procedures were performed without extra ports or conversion.The median age was 62.1 years and 49.0%of the patients had abdominal surgery history.The preoperative median prostate-specific antigen value and prostate volume were 5.0 ng/mL and 33.0 mL,respectively.There were no intraoperative complications.The median operative time and estimated blood loss were 212.5 min and 100.0 mL,respectively.A total of 92.0%of patients were discharged within 24.0 h,with an overall median length of stay of 5.6 h.Only 4.0%of patients required opioid prescriptions at discharge.The median Foley catheter duration was 3 days.Positive margins were present in 15.0%of cases.Median follow-up was 10.4 months.Continence rate was immediate after Foley removal in 49.0%of cases,65.0%at 2 weeks,77.4%at 6 weeks,94.1%at 6 months,and 98.9%at 1 year.One case of biochemical recurrence(1.0%)was noted 3 months after surgery.Conclusion:The SP TV approach for radical prostatectomy cases is a safe and feasible technique for patients with clinically localized prostate cancer.This technique offers advantages of short hospital stay,minimal narcotic use postoperatively,and promising early return of urinary continence,without compromising oncologic outcomes.

Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy:Preliminary results of a prospective comparative study

Objective:Neuraxial anesthesia(NA)showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery.We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy(t-3DLRP)and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia(GA).Methods:A prospective,double-center,double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed.A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.Results:The two group were similar in all demographic,clinical,and pathological variables.Postoperative blood gas parameters were within physiologic limits in both groups.Muscle relaxation was adequate for surgery during both NA and GA.Median length of stay was 1 day shorter for NA group than GA group(5 days vs.6 days,p=0.05).t-3DLRP under NA had a statistically lower rate of minor complications(4.8%vs.19.0%,p=0.03)and less postoperative pain(median numeric rating scale 3 vs.4,p=0.01)compared to GA.No major complications were observed in both groups.Significantly more patients were willing to undergo a similar intervention under NA than GA(p=0.04).Conclusion:t-3DLRP under NA is a feasible and safe procedure,with less postoperative pain and fewer minor complications than the same procedure under GA.NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.

Clinicopathological and oncological significance of persistent prostate-specific antigen after radical prostatectomy:A systematic review and meta-analysis

Objective:To investigate the association of persistently elevated prostate-specific antigen(PSA)after radical prostatectomy(RP)with clinicopathological features and long-term oncological prognosis for the development of a potential management strategy.Methods:A systematic literature search was performed using PubMed and Web of Science up to June 2021 to identify the eligible studies focusing on understanding the impact of persistent PSA in patients who underwent RP for localized prostate cancer.Meta-analyses were performed on parameters with available information.Results:A total of 32 RP studies were identified,of which 11 included 26719 patients with consecutive cohorts and the remaining 21 comprised 24177 patients with cohorts carrying specific restrictions.Of the 11 studies with consecutive cohorts,the incidence of persistent PSA varied between 3.1%and 34.6%with a median of 11.0%.Meta-analyses revealed patients with persistent PSA consistently showed unfavorable clinicopathological features and a more than 3.5-fold risk of poorer biochemical recurrence,metastasis,and prostate cancer-specific mortality prognosis independently,when compared to patients with undetectable PSA.Similarly,cases with persistent PSA in different specific patient cohorts with a higher risk of prostate cancer also showed a trend of worse outcomes.Conclusion:We found that the frequency of persistent PSA was about 11.0%in consecutive RP cohorts.Persistent PSA was significantly associated with unfavorable clinicopathological characteristics and worse oncological outcomes.Patients with persistent PSA after RP may benefit from early salvage treatment to delay or prevent biochemical recurrence,improving oncological outcomes for these patients.Further prospective randomized controlled trials are warranted to understand optimal systemic therapy in these patients.

Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy:A feasibility and accuracy study

Objective:To evaluate the accuracy of our new three-dimensional(3D)automatic augmented reality(AAR)system guided by artificial intelligence in the identification of tumour’s location at the level of the preserved neurovascular bundle(NVB)at the end of the extirpative phase of nerve-sparing robot-assisted radical prostatectomy.Methods:In this prospective study,we enrolled patients with prostate cancer(clinical stages cT1ce3,cN0,and cM0)with a positive index lesion at target biopsy,suspicious for capsular contact or extracapsular extension at preoperative multiparametric magnetic resonance imaging.Patients underwent robot-assisted radical prostatectomy at San Luigi Gonzaga Hospital(Orbassano,Turin,Italy),from December 2020 to December 2021.At the end of extirpative phase,thanks to our new AAR artificial intelligence driven system,the virtual prostate 3D model allowed to identify the tumour’s location at the level of the preserved NVB and to perform a selective excisional biopsy,sparing the remaining portion of the bundle.Perioperative and postoperative data were evaluated,especially focusing on the positive surgical margin(PSM)rates,potency,continence recovery,and biochemical recurrence.Results:Thirty-four patients were enrolled.In 15(44.1%)cases,the target lesion was in contact with the prostatic capsule at multiparametric magnetic resonance imaging(Wheeler grade L2)while in 19(55.9%)cases extracapsular extension was detected(Wheeler grade L3).3D AAR guided biopsies were negative in all pathological tumour stage 2(pT2)patients while they revealed the presence of cancer in 14 cases in the pT3 cohort(14/16;87.5%).PSM rates were 0%and 7.1%in the pathological stages pT2 and pT3(<3 mm,Gleason score 3),respectively.Conclusion:With the proposed 3D AAR system,it is possible to correctly identify the lesion’s location on the NVB in 87.5%of pT3 patients and perform a 3D-guided tailored nerve-sparing even in locally advanced diseases,without compromising the oncological safety in terms of PSM rates.

Role of preoperative magnetic resonance imaging on the surgical outcomes of radical prostatectomy:Does preoperative tumor recognition reduce the positive surgical margin in a specific location?Experience from a Thailand prostate cancer specialized center

Objective Multiparametric magnetic resonance imaging(MRI)has become the standard of care for the diagnosis of prostate cancer patients.This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin(PSM)rates.Methods We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy(RP)at Siriraj Hospital between January 2013 and September 2019.PSM rates were compared between those with and without preoperative MRI.PSM locations were analyzed.Results In total,322(30.1%)patients underwent MRI before RP.PSM most frequently occurred at the apex(33.2%),followed by posterior(13.5%),bladder neck(12.7%),anterior(10.7%),posterolateral(9.9%),and lateral(2.3%)positions.In preoperative MRI,PSM was significantly lowered at the posterior surface(9.0%vs.15.4%,p=0.01)and in the subgroup of urologists with less than 100 RP experiences(32%vs.51%,odds ratio=0.51,p<0.05).Blood loss was also significantly decreased when a preoperative image was obtained(200 mL vs.250 mL,p=0.02).Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex.Neither the surgical approach,the neurovascular bundle sparing technique,nor the perioperative blood loss was associated with PSM.Conclusion MRI is associated with less overall PSM,PSM at apex,and blood loss during RP.Additionally,preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.

Randomized controlled trial comparing open anterograde anatomic radical retropubic prostatectomy with retrograde technique

Objective:Radical prostatectomy is the recommended treatment for localized prostate cancer;however,it is an invasive procedure that can leave serious morbidity.Robot-assisted radical prostatectomy was introduced with the aim of reducing postoperative morbidity and facilitating rapid recovery compared to the traditional Walsh’s open radical retropubic prostatectomy.Therefore,a protocol was developed to perform an open prostatectomy comparable to that performed by robotics,but without involving novel instrumentation.Methods:A total of 220 patients diagnosed with localized prostate cancer underwent radical prostatectomy.They were divided into two groups:anterograde technique(115 patients)and the retrograde method(105 patients).The study outcomes were observed 3 months after surgery.Results:No differences were found in terms of surgical time,hospital stay,and suction drainage.However,reduced bleeding was observed in the anterograde technique(p=0.0003),with rapid anastomosis duration(p=0.005).Among the patients,60.9% undergoing the anterograde technique were continent 3 months after surgery compared to 42.9%treated by the retrograde method(p=0.007).Additionally,fewer complications in terms of the number(p=0.007)and severity(p=0.0006)were observed in the anterograde technique.Conclusion:The anterograde method displayed increased efficiency in reducing complications,compared to the retrograde technique.

Trifecta Outcomes of Screening Detected and Patients with Lower Urinary Tract Symptoms after Open Radical Prostatectomy for Localized Prostate Cancer

Background: Many studies have reported on trifecta outcomes after radical prostatectomy. There is however paucity of studies that compares the trifecta outcome between screen detected and patients presenting with lower urinary symptoms with localized prostate cancer after radical prostatectomy. This study compares the trifecta outcomes between these two groups after an open retropubic radical prostatectomy. Methodology: This is a retrospective study, on the trifecta outcomes (urinary continence, erectile function, and cancer control) of consecutive patients that had open radical retropubic prostatectomy for localized prostate cancer by a single surgeon. Patients were grouped into screen detected and presentation with lower urinary symptoms or retention of urine. The parameters considered were the age of the patients, the total prostate specific antigen (tPSA) at presentation, the clinical T stage, the Gleason score of prostate biopsies, the risk categories using the D’Amico risk groups and the trifecta outcomes after the procedure. Results: In all, 119 patients met the criteria for inclusion. The median follow up was 63.5 months (range 12 - 156 months). Of these 40.3% of the patients were diagnosed through screening with elevated PSA while 59.7% had presented with symptoms of lower urinary tract obstruction. The mean age for the patients was 60.8 ± 6.5 years, median PSA 12.6 ng/ml (IQR 8.6 - 19.7) and median prostate weight of 50.0 (IQR 40.0 - 60 g). The urinary continence rate after the procedure was 93.3%, erection rate of 81.5%, cancer control rate of 71.4% and trifecta achieved in 57.1%. Comparing the screening and the symptomatic cases, the urinary continence rate was 91.7% vrs 94.3%;erectile function rate was 79.2% vrs 83.1%;cancer control 68.8% vrs 73.2% and trifecta achieved in 58.3% vrs 56.3%. There was no statistically significant difference between the two groups in terms of urinary continence p = 0.564, erection function p = 0.588, cancer control p = 0.595, and achieving trifecta p = 0.829. Conclusion: Patients with localized prostate cancer presenting with lower urinary symptoms compared to screen detected patients have similar outcomes in terms of urinary Continence, erectile function, cancer control and trifecta after open radical retropubic prostatectomy.

Radical Prostatectomy: Indication, Technique and Results at Sylvanus Olympio University Hospital Center of Lomé

Aim: Radical prostatectomy started in TOGO for nearly a decade. We purposed to evaluate the indications, technique and result obtained by this practical in our context. Methods: Descriptive retrospective study over 6 years, involves patients who underwent radical prostatectomy in the urology andrology department of the Sylvanus Olympio University Hospital in Lomé. Results: In 6 years, 24 radical prostatectomies were performed on 209 patients with prostate cancer (prevalence 12.92%). The average age of the patients was 63.8 ± 4.2 years. The average PSA rate was 27.9 ± 21.2 ng/ml. 58.3% were at high risk for d’Amico. The retropubic route with ilio-obturator lymph node dissection was the technique used for all patients. 80.9% of patients were continent and 33.3% had a satisfactory erection 12 months after the surgery. Recurrence-free survival at 1 year was 62.5% and 3 deaths or 12.5% were recorded in the first year in high-risk patients. Conclusion: Radical prostatectomy maintains its place of choice in the treatment of localized or locally advanced prostate cancer. It improves recurrence-free survival.

Effect of Comprehensive Nursing Intervention in Patients with Urinary Incontinence After Radical Prostatectomy

Objective:To explore and analyze the clinical effect of comprehensive nursing intervention in patients with urinary incontinence after radical prostatectomy.Methods:84 patients with urinary incontinence after radical prostatectomy admitted to the Urology Department between May 2021 and May 2023 were included in this study.The patients were divided into a comprehensive group and a control group,with 42 cases in each group through a double-blind mechanism.The comprehensive group received comprehensive nursing care,and the control group received primary nursing care.The duration of indwelling urinary catheters and urinary incontinence;psychological performance and living conditions were compared between the two groups.Results:The duration of the indwelling urinary catheter and urinary incontinence of the patients in the comprehensive group were significantly shorter than that in the control group(P<0.05).Before nursing,there was no statistically significant difference in the anxiety,depression,and other psychological manifestations between the two groups(P>0.05);after nursing,the comprehensive group’s anxiety,depression,and other psychological manifestations of the comprehensive group were significantly lower than those of the control group(P<0.05).Before nursing,there was no statistically significant difference in the physical function,mental state,emotional state,and physical recovery of the patients between both groups(P>0.05);after nursing,the physical function,mental state,emotional state,physical recovery of the patients in the comprehensive group were significantly better than those of the control group.Besides,the living conditions of the patients in the comprehensive group were also significantly better than the control group’s(P<0.05).Conclusion:Comprehensive nursing intervention can effectively improve symptoms of urinary incontinence after radical prostatectomy,reduce inner pressure,and improve living standards.

Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer： a comparison with clinically localized prostate cancer

Radical prostatectomy （RP） continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer （PCa）. Recently, RP has also been used in the treatment of locally advanced prostate cancer. However, little research has been performed to elucidate the perioperative complications associated with RP in patients with clinically localized or locally advanced PCa. We sought to analyse the incidence of complications in these two groups after radical retropubic prostatectomy （RRP）. From June 2002 to July 2010, we reviewed 379 PCa patients who underwent RRP in our hospital. Among these cases, 196 had clinically localized PCa （Tla-T2c group 1）, and 183 had locally advanced PCa （ ≥ T3,： group 2）. The overall complication incidence was 21.9%, which was lower than other studies have reported. Perioperative complications in patients with locally advanced PCa mirror those in patients with clinically localized PCa （26.2% vs. 17.8%, P=0.91）. Our results showed that perioperative complications could not be regarded as a factor to consider in regarding RP in patients with cT3 or greater.

Nerve-sparing robot-assisted radical prostatectomy:Current perspectives

Robotic-assisted radical prostatectomy(RARP)is the current standard of care with long term cure in organ-confined disease.The introduction of nerve-sparing(NS)to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological outcomes.This article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes,the neurovascular bundle(NVB),various NS techniques and postoperative functional outcomes.A non-systematic review was done using PubMed,Embase and Medline databases to retrieve and analyse articles in English,with following keywords“prostate cancer”,“robotic radical prostatectomy”,“nerve-sparing”.The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative studies.The literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the other.Variables such as preoperative risk assessments,baseline potency,surgical anatomy of individual patients and surgeons’expertise play a major role in the outcomes.A tailored approach for each patient is required for applying the NS approach during RARP.

Robotic assisted radical prostatectomy accelerates postoperative stress recovery: Final results of a contemporary prospective study assessing pathophysiology of cortisol peri-operative kinetics in prostate cancer surgery

Objective:To investigate the effects of prostate cancer(PCa)surgery on the stress system and to identify potential independent factors associating with stress recovery.Methods:The design of the study was prospective and PCa surgery included robot assisted radical prostatectomy(RARP)or retropubic radical prostatectomy(RRP).Between February 2013 to December 2014,315 consecutive patients were evaluated.The effects of PCa surgery on the stress system were measured by cortisol serum levels before and after surgery on postoperative day(POD)0,1,3,5 and 45.Cortisol variations in the population and subpopulation(RARP vs.RRP)of patients were investigated by statistical methods.Factors associating with stress recovery were assessed by simple linear regression(SLR)and multiple linear regression(MLR)analysis.Results:RARP was performed in 75.9%of cases.In the patient population,there were wide serum cortisol perioperative variations.PCa surgery triggered the stress system which immediately(POD 0)responded by cortisol overproduction which induced the negative feedback mechanism that started on POD 1,continued on POD 3,was still ongoing on POD 5 and completely settled on POD 45(stress recovery).In the subpopulation of patients,significantly lower cortisol serum levels were detected on POD 3e5 in RARP cases inwhomcortisol levels were close to preoperative levels(stress recovery)on POD 5.Independent predictive factors of serum cortisol on POD 5(stress recovery)were preoperative cortisol(p Z 0.02),cortisol levels on POD 3(p<0.0001)and RARP(p Z 0.03)in which the association was negative(stress recovery faster than RRP).Conclusion:Our study shows that PCa surgery immediately(POD 0)triggers the stress system which respond by overproduction of cortisol which induces the negative feedback mechanism that starts on POD 1,is still ongoing on POD 5,but is completely settled on POD 45.Moreover,after surgical trauma,our study gives evidence that the RARP procedure associates with stress recovery faster than RRP.Further confirmatory studies are required.

Influence of bladder neck suspension stitches on early continence after radical prostatectomy： a prospective randomized study of 180 patients

Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck （vesicourethral anastomosis） suspension on the outcome of extraperitoneal endoscopic radical prostatectomy （EERPE）. In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE （nsEERPE） （n=45）, and Group 2 included patients who underwent nsEERPE with bladder neck suspension （BNS, n=45）. Groups 3 （n=45） and 4 （n=45） included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads （pad weighing test） on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were conti nent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group I and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.

Laparoscopic radical prostatectomy： oncological and functional results of 126 patients with a minimum 3-year follow-up at a single Chinese institute

In this study we evaluate the oncological and functional results of the largest cohort of patients in China treated by laparoscopic radical prostatectomy （LRP） and with at least 3 years of follow-up. 126 inconsecutive patients （range 56-78 years, median 62.5） who had an LRP were retrospectively analyzed. The mean prostate specific antigen level and Gleason score was 13.4 ng mL^-1 and 6.4, respectively. Twenty-seven patients had unilateral or bilateral nerve preservation and 29 had pelvic lymphadenectomy. Multivariate analysis was used to adjust for differences in clinical and pathological features when comparing the risk for biochemical progression-free survival （bPFS）. Urinary continence was assessed by incontinence questionnaire and erectile function by the Sexual Health Inventory for Men score. The mean operative duration was 250 min and blood loss 354 mL. Five patients received blood transfusion and nine had complications, including rectal injury （two）, ureteral injury （one）, active bleeding （one）, bladder neck stenosis （two）, paralytic ileus （one）, subcutaneous hematoma （one） and port-site hernia （one）. The overall positive surgical margin rate was 20.6% and correlated with pathological stage and Gleason score respectively （P = 0.03, P 〈 0.001 respectively）. All patients had 〉 3 years of follow-up （range 3-6.75 years, mean 4.6, median 4.75）. At 3 years of follow-up, the overall survival rate was 100% and the bPFS was 81.0% in all patients; 124 patients （98.4%） were continent; 22 of 27 patients （81.5%） who underwent nerve preservation retained erectile function. Our series confirms that LRP is an effective, safe and precise technique at Chinese institution.