obot-assisted laparoscopic radical prostatectomy (RARP). Patients and Methods: We analyzed 1,831 consecutive patients who underwent RARP by a single surgeon. Patients were stratified into three groups on the basis of pathological prostate weight: group 1: 70 g. Continence was defined as the use of ‘no pads’. Potency was defined as the ability to achieve and maintain adequate erections for penetration more than 50% of the time with or without the use of PDE-5 inhibitors. Only patients with preoperative SHIM score >21 and who underwent bilateral nerve-sparing procedure were included in the study. Groups were compared using one-way ANOVA on ranks test and the Dunn’s method for multiple comparisons when statistically significant differences were found. Results: Patients with a larger prostate (group 4) were older (median age 65 years), had higher pre-treatment PSA (median 5.8 ng/ml), higher AUA-SS (median 9), longer operative time (median 80 min) and higher estimated blood loss (median 100 cc) (p
Abstracts of the <strong>21st</strong> Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy 35.89 (range: 17.25-58.16) cm 3 . Two patients received a transurethral resection of the prostate, six and seven years before implant. At one-month post-planning, mean prostate D90 was 143.61 (range: 123.95-166.64) Gy. As a result of experience gained over two years of applying this treatment regime, the time needed to perform the procedure decreased from 270 to 90 minutes. With a median follow-up of nine months, the observed toxicity was low with no acute or late urinary obstruction: 45% and 9% of patients presented grade 1 (G1) and grade 2 (G2) acute GU toxicity, respectively, and only 9% of patients developed G1 acute GI toxicity. A total of 27% of patients presented G1 late GU toxicity not requiring medication. At the time of writing, urinary continence and erectile function are preserved in the whole group. All patients are free from biochemical and local recurrence, with mean PSA values reduced by 70%, 85% and 86.1% at three, six and nine months, respectively. Conclusion: Our data confirm that LDR 125 I brachytherapy is a safe and effective curative modality for selected low-risk prostate cancer patients who wish to maintain erectile function and urinary continence. The outcome seems strongly dependent on a multidisciplinary approach, as well as on the high technical ability of dedicated professionals and the careful selection of the patients to be treated. 1 Taira Al V, Merrick G, Wayne Y et al: Long-term outcome for clinically localized prostate cancer treated with permanent interstitial brachytherapy. Int J Radiation Oncology Biol, in press, 2010. 2 Inciūra A, Jarusevicus L, Vaiciūnas K and Juozaityte E: Review on the effectiveness of prostate cancer brachytherapy. Medicina (kaunas) 45(8): 660-671, 2009. 3 Nag S, Beyer D, Friedland J, Grimm P and Nath R: American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiation Oncology Biol Phys 4: 789-799, 1999. 4 Nath R, Bice WS, Butler WM, Chen Z, Meigooni AS, Narayana V, Rivard MJ and Yu Y: Recommendations on dose prescription and reporting methods for permanent interstitial brachytherapy for prostate cancer: report of Task Group 137. Am Ass Phys Medicine Med Phys 36(11): 5310- 5322, 2009. 139 SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY: SINGLE SURGEON EXPERIENCE Bernardo Rocco 1 , Giancarlo Albo 1 , Pietro Acquati 1 , Kenneth J. Palmer 2 , Sanket Chauhan 2 , Ananth Sivaraman 2 , Rafael F. Coelho 2 and Vipul R. Patel 2 1 Dipartimento di Scienze Chirurgiche Specialistiche Sezione di Urologia, Università degli Studi di Milano Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico U.O. di Urologia, Italy; 2 Global Robotics Institute, Celebration, FL, Italy Aim: The objective of this study is to report the perioperative, functional and oncologic outcomes of salvage robot-assisted radical prostatectomy (sRARP). Patients and Methods: We identified 19 patients who underwent sRARP with bilateral limited pelvic lymph node dissection by a single surgeon between July 2002 and October 2010. RT consisted of XRT in nine cases, brachytherapy in seven cases, brachytherapy plus XRT in two cases and proton beam therapy in one case. Biochemical failure was defined as a PSA of >2.0 ng/ml over the absolute nadir. Continence was defined as the use of ‘no pads’ after surgery and potency was defined as the ability to achieve and maintain adequate erection for penetration, with or without PDE-5 inhibitors. Biochemical recurrence (BCR) was defined as a PSA of >0.2 ng/ml after sRARP. Results: The median (IQR) age, BMI, SHIM score and AUA score were 66 (range: 60-70.5) years, 30 (range: 37-32.5) kg/m 2 , 5 (range: 4- 15), and 12 (range: 7.5-13), respectively. The median PSA nadir after RT and the median PSA before surgery were 4.3 (range: 3.4-4.9) and 1.2 (range: 0.75-1.2) ng/ml, respectively. Six patients were placed on ADT. The median OR time and blood loss were 92.5 (range: 90-107.5) min and 100 (range: 100-100) ml, respectively. A partial nerve-sparing surgery was performed in five (26.3%) patients, while all other patients underwent non nerve-sparing surgery. On histopathological evaluation, five patients (26.3%) had pT2 disease, eight (42.1%) had pT3a, while five (26.3%) had pT3b. Due to intense scarring, it was not feasible to accurately stage one prostate. Three patients (15.8%) had a positive surgical margin. The median Gleason score, prostate weight and tumor volume were 8 (range: 7-8), 34 (range: 25-43) g and 25% (range: 16-32%), respectively. The median length of hospital stay and days on catheter were 1 (range: 1-2) day and 8 (range: 7-11) days, respectively. Two (10.5%) patients had three complications (15.8%). Two patients had anastomosis leak (1d), both treated by extended Foley’s catheterization. One of these developed an anastomotic stricture (Clavien 3a) at six months and was treated by direct internal urethrotomy. There were no rectal injuries or bladder neck contractures. Fifteen patients had at least six months of follow-up, of whom twelve (80%) were continent. The median time to achieve continence was 5.5 (range: 2.6-9) months. Only two patients who had partial nerve-sparing surgery had six months of follow-up, and none of them were potent. On a median followup of 24 (range: 6-45) months, 4 patients (21%) had BCR. Conclusion: sRALP is a technically challenging but feasible procedure. The challenge lies in extensive fibrosis and loss of dissection planes, secondary to radiation therapy. This is the 1883
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