Comparison of functional outcome after extended versus super-extended pelvic lymph node dissection during radical prostatectomy in high-risk localized prostate cancer

Background: Urinary continence and erectile function (EF) are best preserved whenmeticulous dissection of prostate and nerve sparing technique are used during radicalprostatectomy (RP). However, extent of lymph node dissection (LND) may also adverselyaffect functional results.Objective: To determine whether performing a super-extended LND (seLND) has asignificant effect on recovery of urinary continence and EF after RP.Design, setting, and participants: All patients who underwent RP from January 2007until December 2013 were handed questionnaires assessing continence and EF. Allpatients in whom at least an extended LND (eLND) was performed were selected. Thissearch yielded 526 patients. 172 of these patients had filed out 2 or more questionnairesand were included in our analysis.Outcome measurements and statistical analysis: All questionnaires were reviewed.We used Kaplan–Meier analyses and multivariate Cox analysis to assess the differencein recovery of continence and EF over time for eLND/seLND. Primary endpoints were fullrecovery of continence (no loss of urine) and full recovery of EF (successful intercoursepossible). Patients who did not reach the endpoint when the last questionnaire was filledout were censored at that time. Median follow-up was 12.43 months for continence, and18.97 months for EF.results and limitations: Patients undergoing seLND have a lower chance of regainingboth urinary continence [hazard ratio (HR) 0.59, 95% CI 0.39–0.90, p = 0.026] and EF(HR 0.28, 95% CI 0.13–0.57, p = 0.009). Age at surgery had a significant influence onboth continence and EF in multivariate analysis. Major limitation of the study was that noformal preoperative assessment of continence and potency was done.conclusion: Extending the LND template beyond the eLND template may cause atleast a significant delay in recovery of urinary continence and leads to less recovery of EF.</p

Preoperative Risk-Stratification of High-Risk Prostate Cancer: A Multicenter Analysis

Background: Cancer-specific survival (CSS) within high-risk non-metastatic prostate cancer varies dramatically. It is likely that within this heterogenous population there are subgroup(s) at extraordinary risk, burdened with an exaptational poor prognosis. Establishing the characteristics of these group(s) would have significant clinical implications since high quality preoperative risk stratification remains the cornerstone of therapeutic decision making to date. Objective: To stratify high-risk prostate cancer based on preoperative characteristics and evaluate cancer specific survival after radical prostatectomy. Method: The EMPaCT multi-center database offers an international population of non-metastatic high-risk prostate cancer. Preoperative characteristics such as age, biopsy Gleason score, PSA and clinical stage were subcategorized. A multivariate analysis was performed using predictors showing significant survival heterogeneity after stratification, as observed by a univariate analysis. Based upon the hazard ratios of this multivariate analysis, a proportional score system was created. The most ideal group distribution was evaluated trough different score cut-off's. The predictive value was tested by the herald C index. Results: An overall 5-years CSS of 94% was noted within the entire high-risk cohort (n = 4,879). Except for age, all preoperative risk factors showed a significantly differing CSS. Multivariate analysis indicated, T4 stage as being the strongest predictor of CSS (HR: 3.31), followed by ISUP grade 5 group (HR 3,05). A score system was created by doubling the hazard ratios of this multivariate analysis and rounding off to the nearest complete number. Multivariate analysis suggested 0, 4, 8, and 12 pts as being the most optimal group distribution (p-value: 0.0015). Five-years CSS of these groups were 97, 93, 87, and 70%, respectively. The calculated Herald C-index of the model was 0.77. Conclusion: An easy-to-use pre-operative model for risk stratification of newly diagnosed high-risk prostate cancer is presented. The heterogeneous CSS of high-risk non-metastatic prostate cancer after radical prostatectomy is illustrated. The model is clinically accessible through an online calculator, presenting cancer specific survival based on individualized patient characteristics

TRPM8 antagonists to treat lower urinary tract symptoms: don't lose your cool just yet

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Rol en impact van de PSA-test in het kader van prostaatkankerscreening.

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On the origin of bladder sensing: Tr(i)ps in urology

The mammalian TRP family consists of 28 channels that can be subdivided into 6 different classes: TRPV (vanilloid), TRPC (canonical), TRPM (Melastatin), TRPP (Polycystin), TRPML (Mucolipin), and TRPA (Ankyrin). TRP channels are activated by a diversity of physical (voltage, heat, cold, mechanical stress) or chemical (pH, osmolality) stimuli and by binding of specific ligands, enabling them to act as multifunctional sensors at the cellular level. Currently, a lot of scientific research is devoted to these channels and their role in sensing mechanisms throughout the body. In urology, there's a growing conviction that disturbances in afferent (sensory) mechanisms are highly important in the pathogenesis of functional problems. Therefore, the TRP family forms an interesting new target to focus on. In this review we attempt to summarize the existing knowledge about TRP channels in the urogenital tract. So far, TRPV1, TRPV2, TRPV4, TRPM8, and TRPA1 have been described in different parts of the urogenital tract. Although only TRPV1 (the vanilloid receptor) has been extensively studied so far, more evidence is slowly accumulating about the role of other TRP channels in the (patho)physiology of the urogenital tract.status: publishe

Open and robotic radical prostatectomy

Open retropubic radical prostatectomy has been the “gold standard” treatment for locally confined prostate cancer (PCa) but in recent years minimal invasive techniques as laparoscopy and robot-assisted prostatectomy have become widely available. The trifecta of the surgical treatment of PCa is cancer control, the preservation of continence, and erectile potency. Over the years the complication rates of radical prostatectomy have become very limited with improved cancer control and better functional results. We review the indications and the surgical technique of radical prostatectomy, be it open or laparoscopic, eventually robot-assisted as well as the pre- and postoperative measures and the surgery-related consequences. Keywords: Prostate cancer, Radical prostatectomy, Surgery, Robo

Laparoscopy training in Belgium: results from a nationwide survey, in urology, gynecology, and general surgery residents

The purpose of this study was to investigate the exposure of Belgian residents in urology, general surgery, and gynecology to laparoscopic surgery and to training of laparoscopic skills in dedicated training facilities.status: publishe