A Critical Analysis of the Current Knowledge of Surgical Anatomy Related to Optimization of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy

Walz, Jochen; Burnett, Arthur L.; Costello, Anthony J.; Eastham, James A.; Graefen, Markus; Guillonneau, Bertrand; Menon, Mani; Montorsi, Francesco; Myers, Robert P.; Rocco, Bernardo; Villers, Arnauld

doi:10.1016/j.eururo.2009.11.009

Cited by 425 publications

(330 citation statements)

References 103 publications

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“…2) and simplified the operative procedure. In the study conducted by Coelho et al (22), the posterior lip of the bladder neck (full thickness) and the vesicoprostatic muscle (23) were sutured to the posterior urethral edge and the reconstructed median raphe. The procedure described in that study is similar to ours.…”

Section: Discussionmentioning

confidence: 99%

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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Abstract. The aim of this study was to evaluate the efficacy of our modified posterior musculofascial plate reconstruction (PMPR) procedure in laparoscopic radical prostatectomy (LRP). Prior to 2010, four operative procedures were used to expedite continence recovery: preserving the fascia covering the levator ani muscle, preserving the bladder neck, securing a functional urethral length by using a lateral-view dissection technique and suspending the vesicourethral anastomosis from the puboprostatic ligaments. Since February, 2010, a running suture between Denonvilliers' fascia (DF) and the median fibrous raphe (MFR, the fibrous tissue that lies immediately underneath the urethra) has also been used. In vesicourethral anastomosis, a double-armed running suture was performed. At the beginning of the anastomosis, the first stitches (at 1 and 11 o'clock positions on the bladder neck) were placed 1-2 cm dorsocephalad to the bladder neck (first through the seromuscular layer and then through the full thickness of the bladder neck). At the 5 and 7 o'clock positions of the urethra, the stitches were placed through the urethral mucosa as well as the the reconstructed musculofascial plate. The bladder shape was evaluated by postoperative cystography and the clinical results were compared between patients undergoing LRP without PMPR (group A) and those undergoing LRP with PMPR (group B). The cystograms demonstrated that the PMPR significantly shortened the vertical length of the bladder and significantly decreased the posterior vesicourethral angle. At 1, 3 and 6 months after LRP, the number of daily used pads was significantly lower in group B compared to that in group A and the time to achieve a pad-free status was significantly shorter in group B. Our modified PMPR procedure significantly improved the recovery of urinary continence following LRP and this improvement may be due in part to changes of the bladder shape.

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Section: Discussionmentioning

confidence: 99%

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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“…In most of the cases, RP is curative and in several centers represents the first-line treatment choice, even if associated with higher morbidity as compared to other therapeutic options [12]. Recently, treatment approaches that do not involve an intervention, i.e.…”

Section: Discussionmentioning

confidence: 99%

Focal therapy for localized unifocal and multifocal prostate cancer: A prospective development study using real time MR guided focused ultrasound

Napoli¹,

Caliolo²,

Boni³

et al. 2017

AIP Conference Proceedings

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Comparison between high-intensity focused ultrasound devices for the treatment of patients with localized prostate cancer AIP Conference Proceedings 1821, 030002 (2017) Abstract. To assess safety and feasibility of non-invasive high intensity 3T MR guided focused ultrasound (MRgFUS) treatment of localized prostate cancer in an exploratory designed study. Men aged 45-80 years were eligible for this prospective study if they had low-risk localized prostate cancer (prostate specific antigen [PSA] ≤10 ng/mL, Gleason score ≤ 3 + 3), with no previous androgen deprivation or treatment for prostate cancer, and who could safely undergo multiparametric MRI (Discovery 750, GE; Gd-Bopta, Bracco) and have a spinal anesthetic. Patients underwent focal therapy using real time MR guided high intensity focused ultrasound (MRgFUS), delivered to all known cancer lesions, with a margin of normal tissue. Primary endpoints were adverse events (serious and otherwise) and urinary symptoms and erectile function assessed using patient questionnaires. 8 men were recruited between June 2011 and June 2012. After treatment, one man was admitted to hospital for acute urinary retention. Another patient had self-resolving, mild, intermittent dysuria (median duration 5.0 days). Urinary tract infection was not reported. Urinary debris occurred in 6 men (75%), with a median duration of 12 days. Median overall International Index of Erectile Function-15 (IIEF-15) scores were similar at baseline and at 6 to 12 months (p=0.060), as were median IIEF-15 scores for intercourse satisfaction (p=0.433), sexual desire (p=0.622), and overall satisfaction (p=0.256). There was an improvement in lower urinary tract symptoms, assessed by International Prostate Symptom Score (IPSS), between baseline and 6 to 12 months (p=0.026). All 8 men with no baseline urinary incontinence were leak-free and pad-free by 9 months. No histological evidence of cancer was identified in 7 of 8 men biopsied at 6 months (87,5%); overall, the entire population (8 patients) was free of clinically significant cancer and had no evidence of disease on multi-parametric MRI at 6 to 12 months. MR guided Focused Ultrasound focal therapy of individual prostate cancer lesions, whether multifocal or unifocal, leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinically significant prostate cancer.

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“…By means of transrectal compression of the prostate, intraprostatic pressure inside the fibrous prostatic capsule can be increased. 27 Pathological analysis of the prostate tissue immediately after HIFU has shown that the major reason for prostatic swelling is diffuse stromal edema caused by stasis. 15 Compression therapy is the standard approach regarding the suppression of leg edema as a result of stasis.…”

Section: Discussionmentioning

confidence: 99%

Morphological analysis of the effects of intraoperative transrectal compression of the prostate during high‐intensity focused ultrasound for localized prostate cancer

et al. 2015

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Abbreviations & Acronyms 3-D = three-dimensional BDFS = biochemical diseasefree survival rate DVC = dorsal vein complex HIFU = high-intensity focused ultrasound MRI = magnetic resonance imaging PSA = prostate-specific antigen PZ = peripheral zone TRUS = transrectal ultrasound TZ = transition zone Objectives: To evaluate the effects of transrectal compression of the prostate for intraoperative prostatic swelling and intraprostatic point shift during high-intensity focused ultrasound treatment of localized prostate cancer. Methods: Patients treated with whole-gland high-intensity focused ultrasound as primary monotherapy for localized prostate cancer were enrolled in the study. Using the standard and compression method, the volumes of degassed water in the balloon covering the high-intensity focused ultrasound probe were 50 mL and 80-160 mL, respectively. To identify prostatic swelling and shift during high-intensity focused ultrasound and the volume occupied by the non-enhanced area, three-dimensional prostate models were reconstructed using ultrasound and contrast-enhanced magnetic resonance imaging. Results: In comparison with the standard (n = 40) and compression (n = 48) methods, intraoperative increase in the prostate volume (21% vs 5.3%; P = 0.044), intraprostatic point shift (4 mm vs 2 mm, P = 0.040 in the transition zone; 3 mm vs 0 mm; P = 0.001 in the peripheral zone) and the volume occupied by the non-enhanced area (89% vs 96%; P = 0.001) were significantly suppressed. The biochemical disease-free survival rate in patients treated using the compression method was significantly improved relative to the standard method (92.6% vs 76.5%; P = 0.038). Regarding complications, there was no significant difference in the rate of urethral stricture (P = 0.9), urinary tract infection (P = 0.9), incontinence (P = 0.3), erectile dysfunction (P = 0.9) or recto-urethral fistula between the patients treated using the standard and compression methods. Conclusions: Intraoperative transrectal compression suppresses intraoperative increase in the prostate volume and intraprostatic point shift during high-intensity focused ultrasound, having the potential to achieve precise whole-gland and lesion-targeted focal therapy.

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A Critical Analysis of the Current Knowledge of Surgical Anatomy Related to Optimization of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy

Cited by 425 publications

References 103 publications

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Focal therapy for localized unifocal and multifocal prostate cancer: A prospective development study using real time MR guided focused ultrasound

Morphological analysis of the effects of intraoperative transrectal compression of the prostate during high‐intensity focused ultrasound for localized prostate cancer

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