Total reconstruction of the vesico‐urethral junction

Tewari, Ashutosh; Jhaveri, Jay; Rao, Sandhya; Yadav, Rajiv; Bartsch, Georg; Te, Alexis E.; Ioffe, Edward; Pineda, Miguel; Mudaliar, Senthil; Nguyen, Lang; Libertino, John A.; Vaughan, Darracott

doi:10.1111/j.1464-410x.2008.07424.x

Cited by 198 publications

(153 citation statements)

References 10 publications

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“…The Rocco suture was first described in radical retropubic prostatectomy by Rocco in 2007(Rocco et al, 2007 and has been reported by Tewari et al (2008) for its use in RALP. This is a posterior reconstruction to support the urethral sphincter, and it has been used in combination with the Pagano suture, which adds further reinforcement to the posterior bladder neck.…”

Section: Surgical Modificationsmentioning

confidence: 99%

Robotic-assisted laparoscopic prostatectomy

2009

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Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimising outcomes. This article reviews the development and introduction of robotic-assisted laparoscopic radical prostatectomy (RALP), the results to date, and the possible future directions of RALP. Prostate cancer remains a significant health problem worldwide and is the most common cancer affecting men in the United Kingdom, with over 34 000 cases diagnosed in 2005. It is the second leading cause of cancer-related death among men in the UK and the lifetime risk of being diagnosed with prostate cancer is around one in ten. In contrast, in the United States, it is the third commonest cause of cancer-related death among men and the lifetime risk of being diagnosed is one in six, which largely is the consequence of higher rates of PSA testing and screening.Conventional treatment options include radical prostatectomy (RP), external beam radical radiotherapy, brachytherapy and active monitoring or surveillance with or without regular biopsy. More recently, focal therapies such as cryoablation and highintensity focused ultrasound have been introduced, but their oncological effectiveness remains uncertain. Radical prostatectomy is an established and accepted treatment for localised and more recently, for locally advanced prostate cancer. Overall 10-year PSA progression rates after RP are around 30%. Recurrence rates are increased in men with a higher pre-operative PSA, Gleason grade, or tumour stage and if there are positive margins in the pathological specimen.Surgery can be performed by traditional open surgery, or laparoscopically -with or without robotic assistance. This article reviews the development and introduction of robotic-assisted laparoscopic RP (RALP), the results to date, and the possible future directions. In order to concentrate on outcomes when the learning curve has been passed, we have for the purposes of this review included studies where 500 or more cases of RALP have been reported plus other selected references. HISTORY OF RADICAL PROSTATECTOMYThe first perineal prostatectomy was performed by Proust in France in 1901, followed by Young in 1905 in the United States of America who performed the surgery on men with prostate cancer. During the early years, there was significant mortality and morbidity, with some surgeons reporting up to 30% mortality rates. Improvements in technique were made, and Millin's retropubic prostatectomy was used for patients with prostate cancer by Memmelaar and others from the late 1940's. It was not until 1983 that the operation was refined by Walsh who also reported the use of a nerve-sparing procedure to improve postprostatectomy potency rates. The first laparoscopic RP was performed in 1991 by Schuessler and, as with open surgery, advances have been made to improve outcomes, inc...

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Section: Surgical Modificationsmentioning

confidence: 99%

Robotic-assisted laparoscopic prostatectomy

2009

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“…The pathologic stage and PSM rates for open, RLP, and RARP series are summarized on Table 4, 16-22,24-28,30,31,33,55-57 Table 5, 33,37,38,[40][41][42][44][45][46][47] and Table 6, 30,31,35,[48][49][50][51][52][53][54]58 respectively. The pathologic stage in the RARP series was of 78.2% pT 2 tumors and 20.5% pT 3 tumors.…”

Section: Oncologic Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

246

149

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Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms ''prostatectomy'' and ''Outcome Assessment (Health Care)'' and text words ''retropubic,'' ''robotic,'' and ''laparoscopic.'' Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.

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“…Early multi-institutional studies in Japan found the recovery of urinary function following LRP to be slower compared to that following retropubic radical prostatectomy (RRP) (2,3). The operative procedures used to improve the recovery of urinary continence following radical prostatectomy include preserving the fascia covering the levator ani muscle (4), preserving the bladder neck (4), preserving neurovascular bundles (NVBs) (5), securing a longer functional urethra (6,7), reconstructing the posterior musculofascial plate (PMPR) (8)(9)(10), suspending the vesicourethral anastomosis (11) and performing an anterior reconstruction (12).…”

Section: Introductionmentioning

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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Total reconstruction of the vesico‐urethral junction

Cited by 198 publications

References 10 publications

Robotic-assisted laparoscopic prostatectomy

Robotic-assisted laparoscopic prostatectomy

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

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

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