Introduction: We hereby present a new

laparoscopic prostate-preserving cystectomy

technique that aims at reducing sexual dysfunction

and urinary incontinence in comparison

with the conventional technique of

laparoscopic radical cystoprostatectom

Basiri, A.

Mohammad Ali Beigi, F.

shahrekord university of medical scinces

V-05.10Urethral hemangioma-laser treatment:point of techniqueAbara E, Doucet JYork Central Hospital, Richmond Hill,ON, CanadaIntroduction: Urethral hemangiomas areuncommon and sometimes bleeding fromthis can be brisk and troublesome.Methods: A 71-year-old lady with anemiasecondary to bleeding from recurrent ure-thral hemangioma was treated with Hol-mium laser therapy.Results: Treatment resulted in cessationof bleeding and eradication of the heman-gioma.Conclusion: Holmium laser therapy waseffective in this case and should be con-sidered in the management of bleedingand difficult urethral hemangiomas.V-05.11Penile carcinoma: organ sparingsurgeryDjordjevic M, Perovic S, Korac GSchool of Medicine, University of Bel-grade, SerbiaIntroduction: Penile carcinoma is un-common, but when diagnosed, it is psy-chologically devastating to the patient andoften presents a challenge to the urolo-gist. We present organ-sparing surgerybased on penile disassembly technique in38 years old patient with penile carci-noma.Methods: Biopsy previously done con-firms stage one squamous cell carcinoma.Penile disassembly starts with urethralmobilization. The urethra is lifted togetherwith Bucks fascia. Dorsally neurovascularbundle is dissected by blunt and sharpmaneuvers. Glans with urethra ventrallyand neurovascular bundle dorsally is com-pletely separated from corpora cavernosa.Neurovascular bundle is divided 2cm un-der the glans cap. Glans is removed afterdivision of the urethra. Biopsy of the mar-gins confirmed that the resection hasbeen adequate. Urethra is spatulated 4cmin length and fixed to the corpora caver-nosa. Spatulated part is used for creationof neoglans. At proximal level, each cor-pora cavernosa is fixed to the skin usingU- shaped suture in order to avoid postop-erative retraction of the penis. Recon-struction of the penile skin is performedas in circumcision.Results: Six months after surgery goodappearance is achieved. Erectile functionis completely preserved.Conclusion: Organ sparing surgery is themethod of choice in the treatment of low-grade penile carcinoma. It is most impor-tant for young patients to retain a func-tioning penis.V-06: Prostate Cancer/BPOWednesday, November 1510:15-12:15V-06.01Extraperitoneal Laparoscopic RadicalProstatectomy (ELRP)Pen˜a J, Gonzalez J, Hannaoui N, VicenteE, Garcia D, Abad C, Prera A, Prats JServicio de Urologı´a, Hospital de Sa-badell, Corporacio´ Sanitaria Parc Tauli,Sabadell, SpainIntroduction: We present a video of ourinitial experience with the practice of thelaparoscopic radical prostatectomythrough an extraperitoneal access. Surgi-cal steps are shown and commented.Methods: From January 05 to February 06we have started 36 ELRP in our institu-tion. Two of them were performed withthe help of a master. We followed theBrussels technique but without preserva-tion of the neuron vascular bundles.Results: Of the 34 cases performed withoutexternal aid, 23 were completed and 11converted to open surgery. (23 /34, 68%).While of the first 10 we just completed 2,of the last twenty we finished 19 by laparos-copy. Surgical time consumption has dimin-ished from 475 in the first case to 200 min-utes in the last one. Only 1 of 23 requiredblood transfusion. Mean hospitalitation ratehas been 4 days. Conversion to open sur-gery during extraperitoneal laparoscopicprocediment is not very difficult but previ-ous surgical experience is required.Conclusion: ELPR is feasible in an institu-tion like ours (600 beds) but is necessarya team with previous experience in lapa-roscopic surgery and the aim of invest abig effort, specially in what a operatingroom time consumption respects.V-06.02Laparoscopic radical cystoprostaticadenectomyBasiri A, Mohammad Ali Beigi FUrology and Nephrology Research Cen-ter, Shaheed Beheshti University of Medi-cal Sciences, Tehran, IranIntroduction: We hereby present a newlaparoscopic prostate-preserving cystectomytechnique that aims at reducing sexual dys-function and urinary incontinence in com-parison with the conventional technique oflaparoscopic radical cystoprostatectomy.Methods: We performed a laparoscopiccystoprostatic adenectomy with ileal neo-bladder. The plane between the rectumand the bladder was developed. Then, thespace of Retzius was entered, the en-dopelvic fascia was not opened, and thebladder neck was exposed. The lateralbladder pedicles were controlled usingbipolar electocautery. A transverse inci-sion was made on the prostatic capsulenear the bladder neck and was deepenedto reach the prostatic adenoma. The ade-noma was then completely separated fromthe capsule. The Foley catheter was cut inthe urethra, and the distal part waspushed into the bladder. Incision of theprostatic capsule was completed afterenucleating the adenoma. The seminalvesicles were preserved.Results: The operative duration was 180minutes. Estimated blood loss was 250 ml.The patient was discharged on the sev-enth postoperative day. The ureteral cath-eters and the Foley catheter were re-moved 14 and 20 days after the operation,respectively. No intra- or postoperativecomplications occurred. The patient wascompletely potent and continent 1monthafter the operation.Conclusion: It seems, with our techniqueof complete removal of the bladder neckand prostatic adenoma, the risks of posi-tive surgical margins and tumor spillagewere reduced significantly. We proposethis technique in patients with invasivebladder cancer.V-06.03Nerve sparing robotic da Vinci radicalprostatectomyDe Graeve N, Villavicencio H, Salvador J,Palou J, Gomez JFundacio´ Puigvert. Barcelona, SpainIntroduction: The incorporation of newtechnologies, like robotics, puts urologicsurgery at a level, unimagined before.Material and Methods: We present ademonstrative video of a robotic nervesparing radical prostatectomy performedby a surgeon without previous laparo-scopic experience on a 57 year old pa-tient (T1c, preoperative PSA 5.4 ng/ml,positive needle biopsy in the right lobe,Gleason score 33), being the ninth casesince the start of advanced robotics in ourcentre. We show the position of the 6trocars used by the robot and the assis-tant, the installation of the robot withconnection of the trocars, the ergonomi-cally seated position of the surgeon at theconsole, the complete control of the mas-ter handles over the movements of therobotic arms, the movements of the min-VIDEO SESSIONS216 UROLOGY 68 (Supplement 5A), November 2006

V-06.02: Laparoscopic radical cystoprostatic adenectomy

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shahrekord university of medical scinces