Background:The Da Vinci Single-Port Robotic System(Da Vinci-SP),introduced by Intuitive(CA,USA)in 2018 in the USA and in 2024 in Europe,integrates advanced features like a flexible camera and articulating instruments....Background:The Da Vinci Single-Port Robotic System(Da Vinci-SP),introduced by Intuitive(CA,USA)in 2018 in the USA and in 2024 in Europe,integrates advanced features like a flexible camera and articulating instruments.It has garnered significant interest in urology.Our report presents the first described European series of Radical Prostatectomies using the Da Vinci SP at the leading Italian center,Istituto Nazionale Tumori di Napoli,IRCCS“G.Pascale”Foundation,detailing the technical differences and challenges faced by experienced multiport robotic surgeons.Methods:Sixteen patients have been enrolled and underwent Single-Port(SP)Robot-Assisted Radical Prostatectomy(SP-RARP).Baseline characteristics of the patients were collected.We provided a step-by-step description of the surgical technique.Oncological outcomes have been evaluated and compared with magnetic resonance imaging(MRI)and biopsy results.Intraoperative,perioperative,and postoperative complications,surgical outcomes,functional outcomes,and technical issues of the new system were also documented.Results:All surgeries were successfully performed without the need for conversion.An extraperitoneal approach was used for all patients.Median Console time was 110 min.No complications were reported.The estimated median blood loss was 175 cc.Discharge from the hospital was on the first post-operative day for all patients.Bladder catheter removal was on day 7 without the need for cystography.Conclusions:We presented the first European case series of SP-RARP,reporting our experience and confirming the procedure’s feasibility for a highly experienced robotic surgeon.Experience with an extraperitoneal approach using the multiport(MP)platform,combined with well-conducted training for the SP system,may facilitate the transition to SP surgery.Further procedures and studies are needed to evaluate the oncological and functional outcomes.展开更多
Radical prostatectomy is a commonly used surgical method in cases of localized prostate cancer.In recent years,with the advent of new medical technologies and surgical techniques,the evolution of radical prostatectomy...Radical prostatectomy is a commonly used surgical method in cases of localized prostate cancer.In recent years,with the advent of new medical technologies and surgical techniques,the evolution of radical prostatectomy has revolutionized,especially in robot-assisted radical prostatectomy(RARP).The evolution of surgical approaches for radical prostatectomy has occurred in three stages:open surgery,laparoscopic intervention,and robot-assisted surgery.Regarding the functional recovery of patients who underwent laparoscopic radical prostatectomy or RARP,with the improvement of disease conditions,oncological prognosis of patients was not compromised.Particularly,RARP boasts distinguished novel techniques and approaches for maintaining urinary continence and sexual function in the short-and long-term.In addition,studies in the last two decades have shown its correlation with decreasing postoperative morbidity.In this paper,the available literatures related to the surgical approaches ranging from open surgery to RARP were reviewed,the superiority of any novel procedure was analyzed,and the advantages and disadvantages among the three modalities were compared,hoping to provide guidance to urologists when considering surgical approaches in the treatment of localized prostate cancer.展开更多
Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing ur...Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.展开更多
Objective:To evaluate the efficacy and user satisfaction of the MAIA^(TM)telemedicine platform for postoperative telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy(RARP)....Objective:To evaluate the efficacy and user satisfaction of the MAIA^(TM)telemedicine platform for postoperative telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy(RARP).Methods:Patients undergoing RARP(from April 2022 to January 2023)were divided into Group A,following the standard rehabilitation protocol,and Group B using the MAIA^(TM)platform for the first 30-day post-intervention period.Perioperative,pathological,and functional variables(continence and potency rates,assessed via validated questionnaires)were collected and telerehabilitation protocol’s adherence was monitored.The telerehabilitation system included an online platform for medical providers and a patient application,facilitating data acquisition,management,treatment planning,and monitoring.Patient and provider satisfactionwere evaluated using the visual analogue scale score and validated telemedicine satisfaction questionnaire.Results:Totally,227 patients were enrolled.No differences in perioperative or pathological variables were found.Group B had higher potency recovery rates than Group A(p=0.031);the potency recovery rates at 1 month and 3 months for Group B were 45%and 57%,respectively,and in Group A were 34%and 48%,respectively.At the multivariate analysis,MAIA^(TM)use and the nerve-sparing(NS)were independent predictors of erectile function at both 1 month(MAIA^(TM)use:odd ratio[OR]2.03,95%confidence interval[CI]1.13-3.63,p=0.018;NS:OR 2.08,95%CI 1.06-4.12,p=0.034)and 3 months(MAIA^(TM)use:OR 1.89,95%CI 1.07-3.34,p=0.028;NS:OR 1.90;95%CI 1.02-3.54,p=0.044).Adherencemonitoring revealed 4.6%of patients in Group B reported exercise issues due to pelvic pain onset and 10%did not take oral phosphodiesterase 5-inhibitors due to myalgia.All those patients restarted the rehabilitation program after televisit to address the causing problem,allowing restarting of a rehabilitation program.Patients reported high satisfaction with the MAIA^(TM)platform use(mean visual analogue scale score:88.7).Conclusion:The MAIA^(TM)telemedicine platform seems to have a role in optimizing early potency recovery after RARP.Patient and provider satisfaction levels were high,emphasizing the user-friendliness of the platform.展开更多
BACKGROUND Prostate cancer is common among men,and radical surgery is the primary treatment.Surgery,however,can affect both physical and mental health,including anxiety,depression,and quality of life(QoL).AIM To asses...BACKGROUND Prostate cancer is common among men,and radical surgery is the primary treatment.Surgery,however,can affect both physical and mental health,including anxiety,depression,and quality of life(QoL).AIM To assess the effect of radical prostatectomy on psychological status and QoL in patients with prostate cancer.METHODS This observational study included 102 patients undergoing radical prostatectomy between June 2024 and April 2025.Pain(numerical rating scale),Hamilton Anxiety Scale,Hamilton Depression Scale,and QoL(European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and short-form 36)were evaluated before and after surgery.RESULTS At one month postoperatively,the mean European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 score increased significantly from 60.72±5.37 preoperatively to 86.48±7.52(P<0.001),indicating marked improvement in overall QoL.Psychological assessments revealed significant reductions in anxiety and depression:The mean Hamilton Anxiety Scale score decreased from 23.36±5.15 preoperatively to 12.15±4.36(P<0.001),and the mean Hamilton Depression Scale score declined from 22.61±5.02 to 13.83±4.54(P<0.001).Pain levels,as measured by the numerical rating scale,decreased significantly from 7.68±2.17 preoperatively to 2.67±0.72(P<0.001).Additionally,the urinary incontinence rate dropped from 20.59%(21/102)preoperatively to 11.76%(12/102)(P<0.05),showing a statistically significant reduction.CONCLUSION Radical prostatectomy improves psychological health and the QoL of patients with prostate cancer.These results may help to inform future therapies.展开更多
Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2...Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.展开更多
Objective:We investigated patients who underwent robot-assisted radical prostatectomy(RARP)with pelvic lymph node dissection(PLND),analyzing the prevalence and risk factors associated with symptomatic lymphoceles(SLCs...Objective:We investigated patients who underwent robot-assisted radical prostatectomy(RARP)with pelvic lymph node dissection(PLND),analyzing the prevalence and risk factors associated with symptomatic lymphoceles(SLCs).Methods:We evaluated 354 consecutive patients who underwent RARP with PLND by our team between June 2016 and December 2022.After analyzing the prevalence of SLCs,patients were divided into two groups,with and without SLCs.The variables were age,body mass index(BMI),prostate-specific antigen,surgery time,blood loss,length of stay,International Society of Urological Pathology score in the pathology,and the number of lymph nodes removed.These variables were compared between these groups using the Chi-square test and Student's t-test,according to the type of the variable.In all analyses,a significance level of<0.05 was considered.Results:The prevalence of SLCs in this sample of patients undergoing RARP with PLND was 2.0%(7/354),which is slightly lower than the minimum rate reported in the literature.In our analysis,BMI(p=0.041),the number of lymph nodes removed(p=0.007),and length of hospital stay(p=0.007)were factors associated with the presence of SLCs.Conclusion:The prevalence of SLCs in patients undergoing RARP with PLND is approximately 2.0%.Higher BMI,greater number of lymph nodes removed,and longer length of hospital stay are factors associated with the presence of SLCs.展开更多
Despite surgical advancements,erectile dysfunction(ED)is a common consequence of radical prostatectomy(RP).This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitatio...Despite surgical advancements,erectile dysfunction(ED)is a common consequence of radical prostatectomy(RP).This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassisted erectile function(EF)recovery.All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program in the Department of Urology,OORR Policlinico Riuniti(Foggia,Italy)were included.Treatment involved phosphodiesterase type 5 inhibitors(PDE5Is;tadalafil 20 mg,1 tablet every other day),intracavernous injections(Caverject 5µg,1 vial per week),and daily use of vacuum erection devices(VEDs).Primary end point was EF recovery defined as International Index of Erectile Function-5(IIEF-5)≥21 with or without rehabilitation aids.IIEF-5 and prescribed treatments were prospectively collected at 3 months,6 months,9 months,12 months,and 24 months.Among 570 eligible patients,397(69.6%)underwent rehabilitation.Patients who undergoing andro-rehabilitation were younger(65 months vs 70 months;P<0.0001),had lower prostate-specific antigen(PSA)levels(5.9 ng ml−1vs 6.2 ng ml−1;P=0.04),and lower grade tumors(P=0.001)compared to the patients who did not undergo sexual rehabilitation after radical prostatectomy.Two-year EF recovery rates in patients undergoing andro-rehabilitation ranged from 75%(preoperative IIEF-5>16)to 45%(preoperative IIEF-5<16)with rehabilitation aids.Combination treatments(PDE5I+VEDs with or without intracavernous injections)showed the highest rates of EF recovery(up to 80%at 2 years).EF recovery without rehabilitation aids was significantly higher for patients with IIEF-5>21(IIEF-5>21[36%]vs IIEF-5 of 17–21[18%];P=0.01).Subanalysis indicated a moderate benefit of rehabilitation in patients with preoperative IIEF-5<16 who underwent bilateral nerve-sparing RP.Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoing RP.Preserving the neurovascular bundles may be beneficial for patients with preoperative ED.展开更多
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 a...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.展开更多
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 an...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.展开更多
The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March...The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer （PCa） underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1.2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients （age 65 years） and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates I year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.展开更多
To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,compa...To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,comparison was performed between 30 single-port(SP group)and 26 multiport(MP group)cases.Comparisons included operative time,estimated blood loss(EBL),hospital stay,peritoneal violation,pain scores,scar satisfaction,continence,and erectile function.The median operation time and EBL were not different between the two groups.In the SP group,the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients(P<0.001).The median postoperative hospital stay in the SP group was shorter than that in the MP group(P<0.001).The rate of peritoneal damage in the SP group was less than that in the MP group(P=0.017).The pain score and overall need for pain medications in the SP group were lower than those in the MP group(P<0.001 and P=0.015,respectively).Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively(P=0.007).At 3 months,the cancer control,recovery of erectile function,and urinary continence rates were similar between the two groups.It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system.Therefore,epR-spRP can be a treatment option for localized prostate cancer.Although epR-spRP still has a learning curve,it has advantages for postoperative pain and self-assessed cosmesis.In the absence of the single-port robotic surgery platform,we can still provide minimally invasive surgery for patients.展开更多
Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the ...Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.展开更多
To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational...To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.展开更多
Robot-assisted laparoscopic radical prostatectomy （RALRP） using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology. ...Robot-assisted laparoscopic radical prostatectomy （RALRP） using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology. Controversy has surrounded the procedure since it was first performed in 2000, with many critics highlighting the lack of evidence to support its use. However, despite the lack of level I evidence, many large studies of patients have confirmed that the procedure is feasible and safe, with low morbidity. Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy. Functional outcomes also seem satisfactory, although randomized controlled trials are lacking. This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.展开更多
The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU 1005 prospectively evaluated two re...The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU 1005 prospectively evaluated two regimens of maximum androgen blockage or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival （P = 0.004） compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy.展开更多
Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refin...Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure＇s established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.展开更多
This study aimed to assess the role of the National Comprehensive Cancer Network （NCCN） risk classification in predicting biochemical recurrence （BCR） after radical prostatectomy （RP） in Chinese prostate cancer ...This study aimed to assess the role of the National Comprehensive Cancer Network （NCCN） risk classification in predicting biochemical recurrence （BCR） after radical prostatectomy （RP） in Chinese prostate cancer patients. We included a consecutive cohort of 385 patients with prostate cancer who underwent RP at Fudan University Shanghai Cancer Center （Shanghai, China） from March 2011 to December 2014. Gleason grade groups were applied at analysis according to the 2014 International Society of Urological Pathology Consensus. Risk groups were stratified according to the NCCN Clinical Practice Guidelines in Oncology： Prostate Cancer version 1, 2017. All 385 patients were divided into BCR and non-BCR groups. The clinicopathological characteristics were compared using an independent sample t-test, Chi-squared test, and Fisher＇s exact test. BCR-free survival was compared using the log-rank test and multivariable Cox proportional hazard analysis. During median follow-up of 48 months （range： 1-78 months）, 31 （8.05%） patients experienced BCR. The BCR group had higher prostate-specific antigen level at diagnosis （46.54 ± 39.58 ng m1-1 vs 21.02 ± 21.06 ng ml-1, P= 0.001）, more advanced pT stage （P= 0.002）, and higher pN1 rate （P〈 0.001）. NCCN risk classification was a significant predictor of BCR {P = 0.0006） and BCR-free survival （P = 0.003） after RP. As NCCN risk level increased, there was a significant decreasing trend in BCR-free survival rate （Ptrend = 0.0002）. This study confirmed and validated that NCCN risk classification was a significant predictor of BCR and BCR-free survival after RP.展开更多
We evaluated contemporary trends in radical prostatectomy(RP)in men aged>70 years and investigated associations of selected variables with recovery of urinary continence(UC)in two age groups:>70 and<70 years....We evaluated contemporary trends in radical prostatectomy(RP)in men aged>70 years and investigated associations of selected variables with recovery of urinary continence(UC)in two age groups:>70 and<70 years.A retrospective cohort of 2301 eligible patients attending our institution from 2004 to 2015 was reviewed.Patients were divided into two groups based on age at surgery(>70 years[n=610]vs<70 years[n=1691])and four groups by year of surgery.Over the study period,the proportion of patients aged>70 years gradually increased up to 30.0%,and the rate of robot-assisted RP and neurovascular bundle(NVB)saving increased continually to 80.0%and 67.4%of older patients,respectively.Although the rate of recovery of UC within 12 months(3 months)in patients aged>70 years was lower than that in those aged S70 years(81.5%[52.6%]vs 88.6%[60.9%],respectively;both P<0.001),the gap between age groups in the rate of recovery within 12 mon ths n arrowed from the sec ond quarter of the study period.Among youn ger patie nts,age,robot-assisted RP,prostate volume,membra nous urethral length(MUL),and NVB savi ng were predictors of recovery of UC within 3 or 12 months.In contrast,only age and MUL were predictors of recovery of UC within 3 and 12 months in patients aged>70 years.Therefore,unlike younger patients,only variables(age and MUL),possibly associated with the inhere nt fun ction of the urinary sphi ncter,were predictors of recovery of UC in patients aged>70 years.展开更多
This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer （PCa）. A tot...This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer （PCa）. A total of 734 patients with clinically localized PCa who underwent radical prostatectomy （RP） were included in this study. Clinical and pathological data from each patient were collected. Anthropometric measures of abdominal adiposity were measured from T2-weighted sagittal Iocalisation images from magnetic resonance imaging （MRI） for 413 （56.3%） patients. Patient clinical and pathological characteristics were compared across body mass index （BMI） groups. Univariable and multivariable logistic regression models were used to address the influence of the preoperative total testosterone level and anthropometric measures of obesity on pathological outcomes. In the multivariate analysis, BMI was not significantly associated with any pathological outcomes. However, the percentage of visceral adipose tissue （VAT%） was an independent predictor of a pathological Gleason score ≥8 （P〈0.O01）, extracapsular extension （ECE; P=0.002） and seminal vesicle invasion （SVI; P=0.007）. More importantly, we found that the preoperative total testosterone level was significantly correlated with the VAT% （Pearson＇s correlation coefficient： -0.485, P〈0.001） and subcutaneous adipose tissue （SAT; Pearson＇s correlation coefficient： 0.413, P〈0.001）. In conclusion, the results of this study suggest that abdominal fat distribution, and particularly VAT%, is associated with a risk of advanced PCa. Moreover, our present study confirms a significant inverse correlation between visceral adiposity and testosterone. Further studies are warranted to elucidate the biological mechanisms underlying the relationship between abdominal adiposity and the aggressiveness of PCa.展开更多
文摘Background:The Da Vinci Single-Port Robotic System(Da Vinci-SP),introduced by Intuitive(CA,USA)in 2018 in the USA and in 2024 in Europe,integrates advanced features like a flexible camera and articulating instruments.It has garnered significant interest in urology.Our report presents the first described European series of Radical Prostatectomies using the Da Vinci SP at the leading Italian center,Istituto Nazionale Tumori di Napoli,IRCCS“G.Pascale”Foundation,detailing the technical differences and challenges faced by experienced multiport robotic surgeons.Methods:Sixteen patients have been enrolled and underwent Single-Port(SP)Robot-Assisted Radical Prostatectomy(SP-RARP).Baseline characteristics of the patients were collected.We provided a step-by-step description of the surgical technique.Oncological outcomes have been evaluated and compared with magnetic resonance imaging(MRI)and biopsy results.Intraoperative,perioperative,and postoperative complications,surgical outcomes,functional outcomes,and technical issues of the new system were also documented.Results:All surgeries were successfully performed without the need for conversion.An extraperitoneal approach was used for all patients.Median Console time was 110 min.No complications were reported.The estimated median blood loss was 175 cc.Discharge from the hospital was on the first post-operative day for all patients.Bladder catheter removal was on day 7 without the need for cystography.Conclusions:We presented the first European case series of SP-RARP,reporting our experience and confirming the procedure’s feasibility for a highly experienced robotic surgeon.Experience with an extraperitoneal approach using the multiport(MP)platform,combined with well-conducted training for the SP system,may facilitate the transition to SP surgery.Further procedures and studies are needed to evaluate the oncological and functional outcomes.
文摘Radical prostatectomy is a commonly used surgical method in cases of localized prostate cancer.In recent years,with the advent of new medical technologies and surgical techniques,the evolution of radical prostatectomy has revolutionized,especially in robot-assisted radical prostatectomy(RARP).The evolution of surgical approaches for radical prostatectomy has occurred in three stages:open surgery,laparoscopic intervention,and robot-assisted surgery.Regarding the functional recovery of patients who underwent laparoscopic radical prostatectomy or RARP,with the improvement of disease conditions,oncological prognosis of patients was not compromised.Particularly,RARP boasts distinguished novel techniques and approaches for maintaining urinary continence and sexual function in the short-and long-term.In addition,studies in the last two decades have shown its correlation with decreasing postoperative morbidity.In this paper,the available literatures related to the surgical approaches ranging from open surgery to RARP were reviewed,the superiority of any novel procedure was analyzed,and the advantages and disadvantages among the three modalities were compared,hoping to provide guidance to urologists when considering surgical approaches in the treatment of localized prostate cancer.
文摘Objective:Radical prostatectomy(RP)is considered the gold standard treatment for patients with localized prostate cancer(PCa).All patients undergoing RP,either open,laparoscopic,or robotic,are at risk of developing urinary incontinence after RP.Our study aimed to analyze possible predictors of early postoperative(within 3 months)urinary continence(UC)outcomes following extraperitoneal single-site robot-assisted RP(ss-RARP)for localized PCa.Methods:We retrospectively reviewed data from 113 patients with localized PCa who were operated on by a highly experienced surgeon between September 2022 and December 2023.Patient characteristics(age,body mass index,prostate volume,prostate dimensions,preoperative and postoperative membranous urethral length,and percentage of membranous urethra removed)were analyzed using logistic regression to determine the independent factors contributing to short-term UC recovery after extraperitoneal ss-RARP.From the time of urinary catheter removal after surgery,the recovery of UC was followed up every month,and UC was defined as using≤1 safety pad daily,known as social continence.Results:The proportions of continent patients immediately after urinary catheter removal,1 month,and 3 months after extraperitoneal ss-RARP were 22%,49%,and 82%,respectively.The multivariate logistic regression analysis showed that the percentage of membranous urethra removed(p=0.016)and prostate volume(p=0.049)were associated with social UC recovery immediately after urinary catheter removal,and craniocaudal dimension of the prostate(p=0.042)and age(p=0.014)were associated with social UC recovery 1 month and 3 months after extraperitoneal ss-RARP,respectively.Conclusion:The percentage of membranous urethra removed,prostate volume,craniocaudal dimension of the prostate,and age are independent risk factors for social UC early after extraperitoneal ss-RARP.
文摘Objective:To evaluate the efficacy and user satisfaction of the MAIA^(TM)telemedicine platform for postoperative telemonitoring and telerehabilitation in patients undergoing robot-assisted radical prostatectomy(RARP).Methods:Patients undergoing RARP(from April 2022 to January 2023)were divided into Group A,following the standard rehabilitation protocol,and Group B using the MAIA^(TM)platform for the first 30-day post-intervention period.Perioperative,pathological,and functional variables(continence and potency rates,assessed via validated questionnaires)were collected and telerehabilitation protocol’s adherence was monitored.The telerehabilitation system included an online platform for medical providers and a patient application,facilitating data acquisition,management,treatment planning,and monitoring.Patient and provider satisfactionwere evaluated using the visual analogue scale score and validated telemedicine satisfaction questionnaire.Results:Totally,227 patients were enrolled.No differences in perioperative or pathological variables were found.Group B had higher potency recovery rates than Group A(p=0.031);the potency recovery rates at 1 month and 3 months for Group B were 45%and 57%,respectively,and in Group A were 34%and 48%,respectively.At the multivariate analysis,MAIA^(TM)use and the nerve-sparing(NS)were independent predictors of erectile function at both 1 month(MAIA^(TM)use:odd ratio[OR]2.03,95%confidence interval[CI]1.13-3.63,p=0.018;NS:OR 2.08,95%CI 1.06-4.12,p=0.034)and 3 months(MAIA^(TM)use:OR 1.89,95%CI 1.07-3.34,p=0.028;NS:OR 1.90;95%CI 1.02-3.54,p=0.044).Adherencemonitoring revealed 4.6%of patients in Group B reported exercise issues due to pelvic pain onset and 10%did not take oral phosphodiesterase 5-inhibitors due to myalgia.All those patients restarted the rehabilitation program after televisit to address the causing problem,allowing restarting of a rehabilitation program.Patients reported high satisfaction with the MAIA^(TM)platform use(mean visual analogue scale score:88.7).Conclusion:The MAIA^(TM)telemedicine platform seems to have a role in optimizing early potency recovery after RARP.Patient and provider satisfaction levels were high,emphasizing the user-friendliness of the platform.
基金Supported by Shanxi Provincial Higher Education Institutions Scientific and Technological Innovation Program,No.2024083Science and Technology Achievements Promotion Program of Shanxi Provincial Health Commission,No.2024069Academy General Program of First Hospital of Shanxi Medical University,No.YY2209。
文摘BACKGROUND Prostate cancer is common among men,and radical surgery is the primary treatment.Surgery,however,can affect both physical and mental health,including anxiety,depression,and quality of life(QoL).AIM To assess the effect of radical prostatectomy on psychological status and QoL in patients with prostate cancer.METHODS This observational study included 102 patients undergoing radical prostatectomy between June 2024 and April 2025.Pain(numerical rating scale),Hamilton Anxiety Scale,Hamilton Depression Scale,and QoL(European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and short-form 36)were evaluated before and after surgery.RESULTS At one month postoperatively,the mean European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 score increased significantly from 60.72±5.37 preoperatively to 86.48±7.52(P<0.001),indicating marked improvement in overall QoL.Psychological assessments revealed significant reductions in anxiety and depression:The mean Hamilton Anxiety Scale score decreased from 23.36±5.15 preoperatively to 12.15±4.36(P<0.001),and the mean Hamilton Depression Scale score declined from 22.61±5.02 to 13.83±4.54(P<0.001).Pain levels,as measured by the numerical rating scale,decreased significantly from 7.68±2.17 preoperatively to 2.67±0.72(P<0.001).Additionally,the urinary incontinence rate dropped from 20.59%(21/102)preoperatively to 11.76%(12/102)(P<0.05),showing a statistically significant reduction.CONCLUSION Radical prostatectomy improves psychological health and the QoL of patients with prostate cancer.These results may help to inform future therapies.
基金supported by the Interdepartmental Research Project of Peking University First Hospital(No.2023IR27 to Liu Y)the Scientific Research Seed Fund of Peking University First Hospital(No.2023SF40 to Qiu J)+3 种基金the High Quality Clinical Research Project of Peking University First Hospital(No.2022CR75 to Gong K)the Beijing Natural Science Foundation(No.QY23068 to Deng R)the National Natural Science Foundation of China(No.82141103,No.82172617,and No.81872081 to Gong K)the Capital’s Funds for Health Improvement and Research(No.2022-2-4074 to Gong K).
文摘Objective:To explore clinicopathological predictors of adverse pathological changes(APCs)(upgrading,upstaging,and positive surgical margin[PSM])after robot-assisted radical prostatectomy(RARP)in clinical tumor stage 2c(cT2c)prostate cancer(PCa)patients.Methods:From January 2018 to December 2022,cT2cN0M0 PCa patients who underwent prostate biopsies and subsequent RARP at the Peking University First Hospital with an interval between biopsy and RARP of ≤90 days were included.Univariable and stepwise multivariable logistic regression analyses were performed to identify independent risk factors associated with APCs.Nomograms were constructed based on these predictive models.The performance of the nomograms was evaluated by receiver operating characteristic curves,decision curve analyses,and calibration plots.Results:A total of 423 eligible cT2cN0M0 PCa patients were included.The rates of upgrading,upstaging,and PSM in our cohortwere 33%,51%,and 35%,respectively.The stepwise multivariate logistic analysis suggested that PSA density and the percentage of positive cores in systematic biopsy were significantly associated with the occurrence of APCs.The score of the Prostate Imaging Reporting and Data System,PSA density,and the International Society of Urological Pathology grade group(IGG)of needle-biopsy specimens(or clinical IGG[cIGG])were significantly associated with upgrading.The PSA density,percentage of positive cores in systematic biopsy,and largest tumor percentage in all cores of each patient(LTP)were significantly associated with upstaging.The PSA density and LTP were significantly associatedwith the PSM.Based on these results,four nomogramswere developed.Receiver operating characteristic curves,decision curve analyses,and calibration plots implied that the nomograms exhibited excellent accuracy.Conclusion:The predictive models we developed could help to identify high-risk PCa early,and optimize clinical decisions of cT2cN0M0 PCa patients.
文摘Objective:We investigated patients who underwent robot-assisted radical prostatectomy(RARP)with pelvic lymph node dissection(PLND),analyzing the prevalence and risk factors associated with symptomatic lymphoceles(SLCs).Methods:We evaluated 354 consecutive patients who underwent RARP with PLND by our team between June 2016 and December 2022.After analyzing the prevalence of SLCs,patients were divided into two groups,with and without SLCs.The variables were age,body mass index(BMI),prostate-specific antigen,surgery time,blood loss,length of stay,International Society of Urological Pathology score in the pathology,and the number of lymph nodes removed.These variables were compared between these groups using the Chi-square test and Student's t-test,according to the type of the variable.In all analyses,a significance level of<0.05 was considered.Results:The prevalence of SLCs in this sample of patients undergoing RARP with PLND was 2.0%(7/354),which is slightly lower than the minimum rate reported in the literature.In our analysis,BMI(p=0.041),the number of lymph nodes removed(p=0.007),and length of hospital stay(p=0.007)were factors associated with the presence of SLCs.Conclusion:The prevalence of SLCs in patients undergoing RARP with PLND is approximately 2.0%.Higher BMI,greater number of lymph nodes removed,and longer length of hospital stay are factors associated with the presence of SLCs.
文摘Despite surgical advancements,erectile dysfunction(ED)is a common consequence of radical prostatectomy(RP).This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassisted erectile function(EF)recovery.All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program in the Department of Urology,OORR Policlinico Riuniti(Foggia,Italy)were included.Treatment involved phosphodiesterase type 5 inhibitors(PDE5Is;tadalafil 20 mg,1 tablet every other day),intracavernous injections(Caverject 5µg,1 vial per week),and daily use of vacuum erection devices(VEDs).Primary end point was EF recovery defined as International Index of Erectile Function-5(IIEF-5)≥21 with or without rehabilitation aids.IIEF-5 and prescribed treatments were prospectively collected at 3 months,6 months,9 months,12 months,and 24 months.Among 570 eligible patients,397(69.6%)underwent rehabilitation.Patients who undergoing andro-rehabilitation were younger(65 months vs 70 months;P<0.0001),had lower prostate-specific antigen(PSA)levels(5.9 ng ml−1vs 6.2 ng ml−1;P=0.04),and lower grade tumors(P=0.001)compared to the patients who did not undergo sexual rehabilitation after radical prostatectomy.Two-year EF recovery rates in patients undergoing andro-rehabilitation ranged from 75%(preoperative IIEF-5>16)to 45%(preoperative IIEF-5<16)with rehabilitation aids.Combination treatments(PDE5I+VEDs with or without intracavernous injections)showed the highest rates of EF recovery(up to 80%at 2 years).EF recovery without rehabilitation aids was significantly higher for patients with IIEF-5>21(IIEF-5>21[36%]vs IIEF-5 of 17–21[18%];P=0.01).Subanalysis indicated a moderate benefit of rehabilitation in patients with preoperative IIEF-5<16 who underwent bilateral nerve-sparing RP.Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoing RP.Preserving the neurovascular bundles may be beneficial for patients with preoperative ED.
文摘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.
文摘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.
文摘The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer （PCa） underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1.2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients （age 65 years） and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates I year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.
基金This study was supported by the Medical Guidance Project of Shanghai Science and Technology Committee(No.19411967600 and No.17411972000).
文摘To evaluate outcomes between extraperitoneal robotic single-port radical prostatectomy(epR-spRP)and extraperitoneal robotic multiport radical prostatectomy(epR-mpRP)performed with the da Vinci Si Surgical System,comparison was performed between 30 single-port(SP group)and 26 multiport(MP group)cases.Comparisons included operative time,estimated blood loss(EBL),hospital stay,peritoneal violation,pain scores,scar satisfaction,continence,and erectile function.The median operation time and EBL were not different between the two groups.In the SP group,the median operation time of the first 10 patients was obviously longer than that of the latter 20 patients(P<0.001).The median postoperative hospital stay in the SP group was shorter than that in the MP group(P<0.001).The rate of peritoneal damage in the SP group was less than that in the MP group(P=0.017).The pain score and overall need for pain medications in the SP group were lower than those in the MP group(P<0.001 and P=0.015,respectively).Patients in the SP group were more satisfied with their scars than those in the MP group 3 months postoperatively(P=0.007).At 3 months,the cancer control,recovery of erectile function,and urinary continence rates were similar between the two groups.It is safe and feasible to perform epR-spRP using the da Vinci Si surgical system.Therefore,epR-spRP can be a treatment option for localized prostate cancer.Although epR-spRP still has a learning curve,it has advantages for postoperative pain and self-assessed cosmesis.In the absence of the single-port robotic surgery platform,we can still provide minimally invasive surgery for patients.
文摘Robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.
基金supported by grants from the National Natural Science Foundation of China(No.81772741 and No.81972645),Shanghai Jiao Tong University School of Medicine Gaofeng-Clinical Medicine Grant Support(No.20181701)Shanghai Municipal Human Resources and Social Security Bureau(No.2018052)to RNthe Clinical Research Project of Shanghai Health Commission(No.20214Y0511)to YSW.
文摘To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.
文摘Robot-assisted laparoscopic radical prostatectomy （RALRP） using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology. Controversy has surrounded the procedure since it was first performed in 2000, with many critics highlighting the lack of evidence to support its use. However, despite the lack of level I evidence, many large studies of patients have confirmed that the procedure is feasible and safe, with low morbidity. Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy. Functional outcomes also seem satisfactory, although randomized controlled trials are lacking. This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.
文摘The role of adjuvant hormonal therapy and optimized regimens for high-risk localized prostate cancer after radical prostatectomy remains controversial. Herein, the clinical trial CU 1005 prospectively evaluated two regimens of maximum androgen blockage or bicalutamide 150 mg daily as immediate adjuvant therapy for high-risk localized prostate cancer. Overall, 209 consecutive patients were recruited in this study, 107 of whom received 9 months of adjuvant maximum androgen blockage, whereas 102 received 9 months of adjuvant bicalutamide 150 mg. The median postoperative follow-up time was 27.0 months. The primary endpoint was biochemical recurrence. Of the 209 patients, 59 patients developed biochemical recurrence. There was no difference between the two groups with respect to clinical characteristics, including age, pretreatment prostate-specific antigen, Gleason score, surgical margin status, or pathological stages. The maximum androgen blockage group experienced longer biochemical recurrence-free survival （P = 0.004） compared with the bicalutamide 150 mg group. Side-effects in the two groups were similar and could be moderately tolerated in all patients. In conclusion, immediate, 9-month maximum androgen blockage should be considered as an alternative to bicalutamide 150 mg as adjuvant treatment for high-risk localized prostate cancer patients after radical prostatectomy.
文摘Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure＇s established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.
基金This study was sponsored by the National Natural Science Foundation of China （No. 81472377） and the Natural Science Foundation of Shanghai （No. 16ZR1406500）. The authors also thank Wei-Yi Yang, Cui-Zhu Zhang, and Ying Shen for helping with follow-up of patients.
文摘This study aimed to assess the role of the National Comprehensive Cancer Network （NCCN） risk classification in predicting biochemical recurrence （BCR） after radical prostatectomy （RP） in Chinese prostate cancer patients. We included a consecutive cohort of 385 patients with prostate cancer who underwent RP at Fudan University Shanghai Cancer Center （Shanghai, China） from March 2011 to December 2014. Gleason grade groups were applied at analysis according to the 2014 International Society of Urological Pathology Consensus. Risk groups were stratified according to the NCCN Clinical Practice Guidelines in Oncology： Prostate Cancer version 1, 2017. All 385 patients were divided into BCR and non-BCR groups. The clinicopathological characteristics were compared using an independent sample t-test, Chi-squared test, and Fisher＇s exact test. BCR-free survival was compared using the log-rank test and multivariable Cox proportional hazard analysis. During median follow-up of 48 months （range： 1-78 months）, 31 （8.05%） patients experienced BCR. The BCR group had higher prostate-specific antigen level at diagnosis （46.54 ± 39.58 ng m1-1 vs 21.02 ± 21.06 ng ml-1, P= 0.001）, more advanced pT stage （P= 0.002）, and higher pN1 rate （P〈 0.001）. NCCN risk classification was a significant predictor of BCR {P = 0.0006） and BCR-free survival （P = 0.003） after RP. As NCCN risk level increased, there was a significant decreasing trend in BCR-free survival rate （Ptrend = 0.0002）. This study confirmed and validated that NCCN risk classification was a significant predictor of BCR and BCR-free survival after RP.
文摘We evaluated contemporary trends in radical prostatectomy(RP)in men aged>70 years and investigated associations of selected variables with recovery of urinary continence(UC)in two age groups:>70 and<70 years.A retrospective cohort of 2301 eligible patients attending our institution from 2004 to 2015 was reviewed.Patients were divided into two groups based on age at surgery(>70 years[n=610]vs<70 years[n=1691])and four groups by year of surgery.Over the study period,the proportion of patients aged>70 years gradually increased up to 30.0%,and the rate of robot-assisted RP and neurovascular bundle(NVB)saving increased continually to 80.0%and 67.4%of older patients,respectively.Although the rate of recovery of UC within 12 months(3 months)in patients aged>70 years was lower than that in those aged S70 years(81.5%[52.6%]vs 88.6%[60.9%],respectively;both P<0.001),the gap between age groups in the rate of recovery within 12 mon ths n arrowed from the sec ond quarter of the study period.Among youn ger patie nts,age,robot-assisted RP,prostate volume,membra nous urethral length(MUL),and NVB savi ng were predictors of recovery of UC within 3 or 12 months.In contrast,only age and MUL were predictors of recovery of UC within 3 and 12 months in patients aged>70 years.Therefore,unlike younger patients,only variables(age and MUL),possibly associated with the inhere nt fun ction of the urinary sphi ncter,were predictors of recovery of UC in patients aged>70 years.
文摘This study aimed to investigate the association between different anthropometric measures of obesity and clinicopathological characteristics in Chinese patients with clinically localized prostate cancer （PCa）. A total of 734 patients with clinically localized PCa who underwent radical prostatectomy （RP） were included in this study. Clinical and pathological data from each patient were collected. Anthropometric measures of abdominal adiposity were measured from T2-weighted sagittal Iocalisation images from magnetic resonance imaging （MRI） for 413 （56.3%） patients. Patient clinical and pathological characteristics were compared across body mass index （BMI） groups. Univariable and multivariable logistic regression models were used to address the influence of the preoperative total testosterone level and anthropometric measures of obesity on pathological outcomes. In the multivariate analysis, BMI was not significantly associated with any pathological outcomes. However, the percentage of visceral adipose tissue （VAT%） was an independent predictor of a pathological Gleason score ≥8 （P〈0.O01）, extracapsular extension （ECE; P=0.002） and seminal vesicle invasion （SVI; P=0.007）. More importantly, we found that the preoperative total testosterone level was significantly correlated with the VAT% （Pearson＇s correlation coefficient： -0.485, P〈0.001） and subcutaneous adipose tissue （SAT; Pearson＇s correlation coefficient： 0.413, P〈0.001）. In conclusion, the results of this study suggest that abdominal fat distribution, and particularly VAT%, is associated with a risk of advanced PCa. Moreover, our present study confirms a significant inverse correlation between visceral adiposity and testosterone. Further studies are warranted to elucidate the biological mechanisms underlying the relationship between abdominal adiposity and the aggressiveness of PCa.
