Insertion of foreign bodies into the genitourinary system is a pathological action believed to increase sexual gratification usually for psychiatric patients and mentally retarded cases especially during masturbation. In this report, we represented a male case who is inserted a 195 cm cannula by himself into the bladder through the urethra because of his psychiatric disorder.
Objective: This article reports on patients with early stage prostate cancer treated with single plus one port robotic radical prostatectomy (SPORP). Materials and methods: Since January 2014, we performed SPORP in 8 patients with localized prostate cancer. Age of patients, clinical stage, operation time, intraoperative and postoperative complications, blood loss, histopathological evaluation, postoperative continence, serum level of PSA were evaluated. Results: Mean age of the 8 patients was 59.85 years. All operations were completed without conversion to standard robotic procedure or open surgery. No intra operative complications occurred. Mean operating time was 143 minutes; prostate excision 123 minutes and urethrovesical anastomosis 20 minutes. Mean blood loss was 45 ml. Preoperative Gleason scores were (3 + 4) in one patient and (3 + 3) in 7 patients. Postoperative Gleason scores were (3 + 4) in 2 patients, and (3 + 3) in 6 patients. All these 8 cases were in T1c clinical stage. Early postoperative complications were drain leakage (n = 1), atelectasis (n = 1), wound infection (n = 1) and fever (n = 1). There was no positive surgical margin. The serum level of PSA was less than 0.2 ng/ml and no other complications happened during the 4 to 12 months follow-up period. Postoperative continence and cosmetic results were excellent. Conclusions: It is relatively easy for urologists who are skilled in traditional laparoscopic and robotic surgeries to master SPORP. However long-term outcomes of this surgery need further investigations.KEY WORDS: Single plus one port robotic radical prostatectomy (SPORP); Prostate cancer; Initial experience; Radical prostatectomy.
SummaryNo conflict of interest declared.
ÖZAmaç: Bu çalışma ile prostat kanseri nedeniyle robot yardımlı radikal prostatektomi yapılan hastalarda kontinansı etkileyen faktörleri değer-lendirmeyi amaçladık. Yöntemler: Ağustos 2009 -Ocak 2014 tarihleri arasında Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Üroloji Kliniğinde prostat kanseri nedeniyle Robot yardımlı laparaskopik radikal prostatektomi uygulanan 385 hastanın verileri retrospektif olarak incelendi. Bulgular: Preop Uluslararası Erektil İşlev İndexi (IIEF) skoru ≥22 olanlar ile D'Amico sınıflamasına göre düşük riskli hastalarda 12.aydaki kontinans oranı istatistiksel olarak anlamlı yüksek saptandı (p<0,05). Üçüncü aydaki değerlendirmede klasik interfasyal teknik, klasik intrafasyal teknik ve fasya koruyucu intrafasyal teknik uygulanan hastaların klasik ekstrafasyal teknik uygulanan hastalara göre kontinans oranı istatistiksel olarak anlamlı yüksek saptandı (p<0,05). Sinir koruyucu cerrahi yapılan hastalar ile sinir koruyucu cerrahi yapılmayan hastalar karşılaştırıldığında sinir koruyucu cerrahi yapılan hastalarda kontinans oranı istatistiksel olarak anlamlı yüksek saptandı (p<0,05). Sonuç: Biz erken ve geç kontinansın geri kazanılmasında klasik intrafasyal ve fasya koruyucu intrafasyal tekniğin önemli olduğunu saptadık. Bununla birlikte geç kontinansın geri kazanılmasında, hastaların preop IIEF skorunun yüksek olmasının ve D'Amico sınıflamasına göre düşük risk grubunda olmasının önemli olduğunu saptadık. Anahtar kelimeler: Radikal prostatektomi, kontinans, prostat kanseri, robotyardımlıcerrahi ABSTRACT Objective: Objective: In this study, we aimed to evaluate the factors affecting continence in patients who underwent robot-assisted radical prostatectomy for prostate cancer. Methods: Between August 2009 and January 2014, data of 385 patients, who were treated with robot-assisted laparoscopic prostatectomy for prostate cancer at our clinic, was retrospectively analyzed. Results: The continence rate was significantly higher at the 12-month evaluation in patients who preoperatively had an International Index of Erectile Function (IIEF) score of >22 and who were at a low risk according to the D'Amico classification (p<0.05). The continence rate was significantly higher at the 3-month evaluation in patients who underwent interfascial, classical intrafascial, and fascia-sparing intrafascial techniques compared with those who underwent the classical extrafascial technique. The continence rate was significantly higher in patients who underwent a nerve-sparing surgery. Conclusion: We found that for the recovery of early and late continences, the use of classical intrafascial and fascia-sparing intrafascial techniques is important. However, we have determined that being at a low risk according to the D'Amico classification and having a high IIEF score are important for the recovery of late continence.
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