Objective: To study the effect of a novel technique of posterior reconstruction of pubourethralis on early return of continence after robot assisted radical prostatectomy (RARP). Materials and methods: The study included 206 patients of organ confined prostate cancer managed at our centre between March 2014 and December 2018.The patients were randomly distributed into two comparable groups with respect to age, height, weight and BMI, with 100 patients in control and 106 patients in study group. After standard excision of the specimen, the posterior reconstruction in the form of Rocco stitch was done in control group while in addition to Rocco stitch pubourethralis was approximated posteriorly in midline at the proposed site of vesicourethral anastomosis in study group. Continence was defined as the need to use 0–1 pad in 24 h. The data was collected on day 0, 3, 7, 15, 30, 90 and 180 after removal of catheter. Results: At day zero, 3,7, 15, 30, 90 and 180 days after catheter removal continence rates (⩽1 pad usage per day) were observed to be 18.8% versus 0%, 22.6% versus 0%, 50.9% versus 5%, 72.6% versus 20%, 84.9 versus 32%, 97.1% versus 83%, and 97.1% versus 91% in the study and control group respectively. Conclusion: Despite small number of patients in this study the results with respect to early return of continence are encouraging in the reconstruction group and there by in favour of this technique .Furthermore the technique is easily reproducible and may be seen as one more additional step to be applied in order to enhance the recovery of continence after RARP. However it is necessary to further validate the efficacy of this procedure through multicenteric controlled trials.
Objectives: To analyze whether technical modifications during transurethral resection of the prostate/holmium laser enucleation of the prostate results in preservation of antegrade ejaculation, at the same time providing effective relief from bladder outlet obstruction. Materials and methods: A total of 119 patients with benign prostatic hyperplasia were included in the study carried out at our center between March 2016 and December 2018. The patients were divided into two groups, with 56 (47.06%) patients in the ejaculation-preserving transurethral resection of the prostate group and 63 (52.94%) patients in the ejaculation-preserving holmium laser enucleation of the prostate group. The patients in the two groups were assessed with respect to age, prostate size, serum prostate-specific antigen and any comorbidity. The parameters assessed pre and postoperatively include Qmax, international prostate symptom score, peripheral vascular resistance, overall sexual satisfaction and overall ejaculation. All patients were regularly followed up during the study period and were included in the final analysis. Results: The mean (standard deviation) age, prostate size, serum prostate-specific antigen of patients who underwent ejaculation-preserving transurethral resection of the prostate and patients who underwent ejaculation-preserving holmium laser enucleation of the prostate was 61.67 (5.26)/61.48 (5.40) years, 59.75 (10.61) ml/74.44 (20.27) ml, 2.38 (0.77) ng/ml/2.47 (0.83) ng/ml, respectively. Postoperatively there was a statistically significant improvement in Qmax, international prostate symptom score and peripheral vascular resistance in both groups. The overall sexual satisfaction after surgery improved significantly in the ejaculation-preserving transurethral resection of the prostate group; however, it deteriorated significantly in the ejaculation-preserving holmium laser enucleation of the prostate group, which was statistically significant at 6 months. After treatment, the overall ejaculation assessed by asking question 9 of the international index of erectile function 15 questionnaire was unchanged in patients from the ejaculation-preserving transurethral resection of the prostate group and deteriorated in the ejaculation-preserving holmium laser enucleation of the prostate group and the difference between the two groups was statistically significant. Conclusion: An ejaculation preserving technique seems to be more feasible in small prostate glands when appreciable apical tissue is spared. However, holmium laser enucleation of the prostate is basically a size-independent procedure and enables the complete removal of the adenoma tissue like an open prostatectomy. To compromise the extent of tissue removal or candidate selection for a better ejaculation preservation outcome might damage the indigenous value of the holmium laser enucleation of the prostate. To conclude, if the preservation of sexual satisfaction and ejaculatory function is a priority, patients should be offered ejaculation-preserving transurethral resection of the prostate as the treatment of choice over ejaculation-preserving holmium laser enucleation of the prostate.
Aim: To study the outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. Materials and methods: A prospective study of carried out from 2016 to 2019. A total of 15 patients were included in the study with a lesion (angiomyolipoma) more than 10 cm in size, suitable for nephron sparing surgery. The workup of the patients included history, baseline blood investigations, ultrasonography, and CT urography including angiographic films. All the patients were taken up for selective of angioembolization of the feeding vessels of the AML carried out by the interventional radiologist followed by nephron sparing surgery in the same sitting. The short term outcomes studied were warm ischemia time, average blood loss, and length of post-operative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen and functional outcome by assessing the function of the preserved renal parenchyma. Results: Twelve out of fifteen cases were female. The mean age was 42.25 years. All the patients had lesion more than 10 cm with seven tumors located at the lower pole, four at mid-pole, and four at upper pole. Eight patients had low complexity score on RENAL score (i.e. 4–6), five patients medium complexity score (i.e. 7–9), and two had high complexity score (i.e. ⩾10). Average blood loss was 200 ml, warm ischemia time was 18.46 min and postoperative stay was 3.55 days. All the 15 specimens sent for histopathology were confirmed as AML (angiomyolipomas) with margins free of tumor. Follow up CECT done at 4 months postoperatively revealed functioning residual renal parenchyma with prompt excretion of contrast. Conclusion: Large AML’s are also amenable to nephron sparing surgery. However patient should always be warned about the possibility of total nephrectomy. Selective angioembolization helps in reducing the blood supply and risk of torrential bleeding thus facilitates in the removal of the tumor and increasing the chances of nephron sparing surgery.
Objective: To analyze 68-Ga prostate-specific membrane antigen (PSMA) uptake pattern of the prostate and its correlation with prostate-specific antigen (PSA), digital rectal examination (DRE), and Gleason’s score in the diagnosis of carcinoma of the prostate (CaP). Methods: This was a retrospective study conducted between June 2015 and August 2017. Patients who had undergone whole body 68-Ga PSMA HBED-CC simultaneous positron emission tomography (PET) or magnetic resonance imaging (MRI) for the diagnosis or staging of CaP were eligible. Patients who presented with persistently raised serum PSA (>4 ng/mL) and normal urine routine and negative culture were included in the study. Results: A total of 74 patients were included in the study. Significant positive correlation was observed between PSMA delayed uptake with the Prostate Imaging Reporting and Data System (PI-RADS) score ( p<0.001, ρ=0.750), PSA level ( p<0.001, ρ=0.414), DRE ( p<0.002, ρ=0.400), and Gleason’s score ( p<0.300, ρ=0.02). There was a significant difference between early and delayed phase of PSMA uptake in malignant prostatic lesions ( p<0.001). Delayed phase of PSMA uptake was able to characterize prostate lesions with an area under curve (AUC) of 0.91. Combined receiver operating characteristic analysis of PI-RADS score derived from multiparametric MRI and differential PSMA uptake to characterize prostatic lesions improved AUC to 0.94. Conclusion: Results demonstrated that the correlation with clinicopathological features (PSA, DRE, and Gleason’s score) could be used in prognostication of prostatic lesion along with PSMA PET/MRI.
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