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Marmara Medical Journal 2011; 24 (1):10-14 DOI: 10.5472/MMJ.2010.01744.1Original Article / Özgün AraştırmaRadical Retropubic Prostatectomy – A Review of the CurrentLiterature and a Study of 250 Cases at Marmara UniversityRadikal Retropubik Prostatektomi – Güncel Literatür Derlemesi ve Son 250 Vaka İleMarmara Tecrübesiİlker TİNAY, Mahir Bülent ÖZGEN, Çağrı Akın ŞEKERCİ, Levent TÜRKERİDepartment of Urology, School of Medicine, Marmara University, İstanbul, TürkiyeABSTRACTObjective: To review the current literature of open radicalretropubic prostatectomy and report the results of the last250 open radical retropubic prostatectomies performed inour University clinic.Patients and Methods: A literature review wasperformed using the PubMed database with combinationsof the following keywords radical prostatectomy, openretropubic, prostate cancer, complications andcomorbidity. Charts of the most recent 250 consecutivepatients who had undergone radical retropubicprostatectomy at the Urology Department of MarmaraUniversity School of Medicine were reviewed.Results: In 69.2% of the cases the tumor was confinedwithin the prostate gland, whereas 30.8% of the caseshad tumors with either positive surgical margins, capsularpenetration, invasion of seminal vesicles or a combinationof these features. Nerve-sparing radical retropubicprostatectomy patients were found to be more successfulin achieving continence and erectile function in the postoperativeperiod. Cancer progressions were experiencedin 12.4% of the cases following radical retropubicprostatectomy at a mean follow-up of 53.8 months with amean time to progression of 20.7 months.Conclusion: The three goals of radical prostatectomy;cancer control, preservation of urinary control andpreservation of sexual function were achieved with thelong-time experience of open radical prostatectomy.Keywords: Radical prostatectomy, Open retropubic,Prostate cancer, Complications, ComorbidityÖZETAmaç: Açık radikal retropubik prostatektomi hakkındakigüncel literatürün derlenmesi ve üniversite kliniğimizdeyapılan son 250 açık radikal retropubik prostatektomivakalarının sonuçlarının bildirilmesi.Materyal ve Metot: Radikal prostatektomi, açıkretropubik, prostat kanseri, komplikasyonlar vekomorbidite anahtar kelimeleri seçildi ve Pubmedveritabanı kullanılarak literatür taraması yapıldı.Marmara Üniversitesi Tıp Fakültesi Üroloji AnabilimDalı’nda yapılan son 250 açık radikal retropubikprostatektomi vakasının dosyaları tarandı.Bulgular: Hastaların % 69, 2’sinde tümör prostat beziile sınırlı kalırken, % 30.8’inde pozitif cerrahi sınır,kapsül invazyonu, seminal vezikül invazyonu ya dabunların kombinasyonu saptandı. Sinir koruyucu radikalretropubik prostatektomi hastalarının ameliyat sonrasıdönemde idrar kontinansını ve erektil işlevi gerikazanmalarının daha başarılı olduğu saptandı. Radikalretropubik prostatektomi sonrası vakaların % 12, 4’ündeortalama 53,8 aylık takip ve ortalama 20,7 ayprogresyon süresi ile kanser progresyonu saptandı.Sonuç: Radikal prostatektominin üç hedefi olan; kanserkontrolü, idrar kontrolünün korunması ve cinsel işlevinkorunması hedeflerine, açık radikal retropubikprostatektominin uzun dönem tecrübesi ile ulaşılmıştır.Anahtar Kelimeler: Radikal prostatektomi, Açıkretropubik, Prostat kanseri, Komplikasyonlar,KomorbiditeBaşvuru tarihi / Submitted: 23.11.2010 Kabul tarihi / Accepted: 20.12.2010Correspondence to: İlker Tinay, M.D. Marmara Üniversitesi Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbul,Türkiye. e-mail: ilker_tinay@yahoo.com10Marmara Medical Journal 2011; 24 (1):10-14
İ. TİNAY, et alRadical retropubic prostatectomyINTRODUCTIONProstate cancer (PCa) is the mostfrequently diagnosed cancer and second leadingcause of cancer-related deaths in the malepopulation in the United States 1 . In Europe, PCa isthe most common solid neoplasm, with an incidencerate of 214 cases per 1000 men, outnumbering lungand colorectal cancer 2 .With the increasing use of prostate-specificantigen (PSA) testing, men are being diagnosedwith earlier stage PCa and at a younger age, andthey become candidates for curative therapy.Radical prostatectomy offers the best long-termcancer control for clinically localized disease.Radical prostatectomy was first applied atthe beginning of the 20th century by Young 3 using aperineal approach, while Memmelaar and Millinwere the first to perform retropubic radicalprostatectomy 4 . Walsh and Donker described theanatomy of the dorsal venous complex and theneurovascular bundles 5 . Their description of theopen “nerve-sparing” radical prostatectomy hasbecome the gold standard surgical treatment forPCa for the past 30 years.Technically, radical retropubicprostatectomy is one of the most difficult operationsin the field of urology. The three goals of thesurgeon, in order of importance, are cancer control,preservation of urinary control, and preservation ofsexual function 6 . There is no age threshold forradical prostatectomy and a patient should not bedenied this procedure on the grounds of age alone 7 .Several large series with a long-term follow-up haveconfirmed that this approach results in excellentcancer control and functional results in terms ofpreservation of erectile function and urinarycontinence 8-10 .In this study, we review the currentliterature of open radical retropubic prostatectomyand report the results of the last 250 open radicalretropubic prostatectomies performed in ouruniversity clinic.PATIENTS and METHODSSubjectsThis study comprises the most recent 250consecutive patients who had undergone radicalretropubic prostatectomy for clinically localized(stage T2c or lower) carcinoma of the prostate at theUrology Department of Marmara University Schoolof Medicine. All office and hospital charts werereviewed.StagingPreoperative evaluation of all patientsincluded a digital rectal examination by an urologist,a serum PSA determination and radioisotope bonescanning with confirmatory imaging studies whennecessary. Many men also underwent abdominaland pelvic computerized tomography or magneticresonance imaging.All tumors were clinically staged accordingto the TNM classification:T1 - Clinically inapparent tumour notpalpable or visible by imaging• stage Tla -cancer incidentallyfound at transurethral prostatic resection or openadenomectomy involving less than 5% of resectedtissue• stage Tlb - cancer incidentallyfound at transurethral prostatic resection or openadenomectomy involving greater than 5% ofresected tissue• stage Tlc - cancer identified byneedle biopsy because of elevated PSA in thepresence of normal digital rectal examinationT2 - Tumour confined within the prostate• stage T2a - tumor involving onehalf of a lobe of the prostate or less• stage T2b - tumor involving morethan half of one lobe but not both lobes of theprostate• stage T2c - tumor involving bothlobes of the prostateSurgical TechniqueOne surgeon (LT) performed radicalretropubic prostatectomy with a previously reportedtechnique, which was based on the anatomicalapproach for radical prostatectomy described byWalsh 6 . Briefly, radical prostatectomy involves theremoval of the entire prostate gland between theurethra and the bladder, and resection of bothseminal vesicles along with sufficient surroundingtissue to obtain a negative margin. Often, thisprocedure is accompanied by a bilateral pelviclymph node dissection. Achieving negative surgicalmargins was the primary concern, followed bypreservation of continence and erectile function withthe nerve-sparing approach. We developed a newurethrovesical anastomotic suture technique andhave been utilizing it since 2004 11 .Measures of Incontinence and ErectileDysfunctionPostoperative urinary continence wasassessed with the International Continence SocietyMale Short Form (ICS-SF) and was defined ascomplete continence (no pads), minimalincontinence (1 precautionary pad per day) ormoderate to severe incontinence (2 or more padsper day) 12 .The National Institute of Health (NIH)Consensus Panel has defined erectile dysfunction(ED) as the inability to achieve and/or maintainpenile erection sufficient for satisfactory sexualperformance. We used the International Index ofErectile Function (IIEF-5) as the diagnostic tool forerectile function pre- and postoperatively 13 .Both questionnaires were completedbefore and at varying periods after surgery.Follow-Up Evaluation11Marmara Medical Journal 2011; 24 (1):10-14
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Page 6 and 7: Tablo başlıkları ve şekil altya
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Page 10 and 11: D. G. YAVUZ ve arkBir tıp fakülte
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Page 24 and 25: P. SAĞIROĞLU ve arkStreptococcus
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