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The purpose of this study is to evaluate whether the periprostatic adipose tissue thickness (PPATT) is an independent prognostic factor for prostate cancer patients after laparoscopic radical prostatectomy (LRP). This retrospective cohort study included consecutive prostate cancer patients who underwent LRP treatment at Wuhan Union Hospital from June 2, 2016, to September 7, 2023. PPATT was defined as the thickness of periprostatic fat and was obtained by measuring the shortest vertical distance from the pubic symphysis to the prostate on the midsagittal T2-weighted MR images. Subcutaneous adipose tissue thickness (SATT) was obtained by measuring the shortest vertical distance from the pubic symphysis to the skin at the same slice with PPATT. The primary outcome of the study was biochemical recurrence (BCR), and the secondary outcome was overall survival (OS). Multivariable Cox regression analysis was used to identify independent prognostic factors for prostate cancer survival and prognosis. Based on the optimal cutoff value, 162 patients were divided into a low PPATT/SATT group (n = 82) and a high PPATT/SATT group (n = 80). During the entire follow-up period (median 23.5 months), 26 patients in the high PPATT/SATT group experienced BCR (32.5%), compared to 18 in the low PPATT/SATT group (22.0%). Kaplan–Meier curve analysis indicated that the interval to BCR was significantly shorter in the high PPATT/SATT group (P = 0.037). Multivariable Cox regression analysis revealed that an increase in the PPATT/SATT ratio was associated with BCR (hazard ratio: 1.90, 95% CI, 1.03–3.51; P = 0.040). The PPATT/SATT ratio is a significant independent risk factor for BCR after LRP for prostate cancer patients. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study is to evaluate whether the periprostatic adipose tissue thickness (PPATT) is an independent prognostic factor for prostate cancer patients after laparoscopic radical prostatectomy (LRP). This retrospective cohort study included consecutive prostate cancer patients who underwent LRP treatment at Wuhan Union Hospital from June 2, 2016, to September 7, 2023. PPATT was defined as the thickness of periprostatic fat and was obtained by measuring the shortest vertical distance from the pubic symphysis to the prostate on the midsagittal T2-weighted MR images. Subcutaneous adipose tissue thickness (SATT) was obtained by measuring the shortest vertical distance from the pubic symphysis to the skin at the same slice with PPATT. The primary outcome of the study was biochemical recurrence (BCR), and the secondary outcome was overall survival (OS). Multivariable Cox regression analysis was used to identify independent prognostic factors for prostate cancer survival and prognosis. Based on the optimal cutoff value, 162 patients were divided into a low PPATT/SATT group (n = 82) and a high PPATT/SATT group (n = 80). During the entire follow-up period (median 23.5 months), 26 patients in the high PPATT/SATT group experienced BCR (32.5%), compared to 18 in the low PPATT/SATT group (22.0%). Kaplan–Meier curve analysis indicated that the interval to BCR was significantly shorter in the high PPATT/SATT group (P = 0.037). Multivariable Cox regression analysis revealed that an increase in the PPATT/SATT ratio was associated with BCR (hazard ratio: 1.90, 95% CI, 1.03–3.51; P = 0.040). The PPATT/SATT ratio is a significant independent risk factor for BCR after LRP for prostate cancer patients.

Abstract Purpose To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables. Methods We retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from immediate and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Sixteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP. Results After eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction(P

Purpose: To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables. Methods: We retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from immediate and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Sixteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP. Results: After eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction(P < 0.001), and at 3 mo (P < 0.001), 6 mo (P < 0.001) and 12 mo (P = 0.009) after surgery. Conclusion: MUL is a significant independent factor that can contribute to short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment. [ABSTRACT FROM AUTHOR]

Nerve-sparing radical prostatectomy (NSRP) for prostate cancer (PC) enables better postoperative recovery of continence and potency but may increase the risk of positive surgical margins. This study aimed to investigate preoperative predictive factors for extracapsular extension (ECE) of PC to select patients for NSRP. We retrospectively evaluated 288 patients with PC (576 lobes) diagnosed with 12-core transrectal ultrasound-guided biopsy and magnetic resonance imaging (MRI) who underwent laparoscopic or robot-assisted radical prostatectomy at our institution. Surgical specimens and preoperative parameters (prostate-specific antigen, prostate volume, biopsy and MRI findings, preoperative therapy) were analyzed. Of 576 prostate lobes, the incidence Ipsilateral ECE was identified in 97 (16.8%) lobes. The higher number of unilateral positive biopsy cores, the highest Gleason score 8 or more and positive unilateral findings on MRI are significant higher in prostate sides with ECE in univariate analysis. In multivariate analysis, positive unilateral MRI findings (odds ratio [OR], 2.86; p < 0.001) and unilateral biopsy positive core ≥ 3 (OR, 3.73; p < 0.001) were independent predictors of unilateral ECE. The detection rate of unilateral ECE in those cases with two factors (side-specific positive biopsy core 2 or less and side-specific MRI findings negative) was 7.1% (19/269). Patients with fewer unilateral positive biopsy cores and negative unilateral MRI findings might be good candidates for NSRP. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between serum high mobility group protein B1 (HMGB1), circulating tumor cells (CTCs) and albumin/alkaline phosphatase ratio (AAPR) and postoperative biochemical recurrence in patients undergoing laparoscopic radical prostatectomy (LRP). Methods: 169 patients with LRP admitted to the Second Affiliated Hospital of Soochow University from January 2018 to July 2020 were selected, and they were divided into biochemical recurrence group and non-biochemical recurrence group according to the occurrence of postoperative biochemical recurrence. Serum HMGB1, peripheral blood CTCs were detected, and AAPR was calculated. Multivariate Logistic regression was used to analyze the influencing factors of postoperative biochemical recurrence in patients with LRP, and the predictive value of serum HMGB1, CTCs and AAPR for postoperative biochemical recurrence in patients with LRP was analyzed by receiver operating characteristics (ROC) curve. Results: After 2 years of follow-up, the incidence rate of postoperative biochemical recurrence in 169 patients with LRP was 25.44% (43/169). Compared with non-biochemical recurrence group, serum HMGB1 and CTCs in the biochemical recurrence group were higher, and AAPR was lower (P＜0.05). Multivariate Logistic regression analysis showed that Clinical stage T2 stage, prostate specific antigen (PSA) > 20 ng/mL, elevated HMGB1 and CTCs, Gleason score 8 scores were independent risk factors for postoperative biochemical recurrence in patients with LRP. The elevated free prostate specific antigen/total prostate specific antigen (fPSA/tPSA) and AAPR were independent protective factors (P＜0.05). ROC curve analysis showed that the area under the curve predicted by serum HMGB1 combined with CTCs and AAPR for postoperative biochemical recurrence in LRP patients was 0.881, which was greater than that predicted by HMGB1, CTCs, and AAPR alone. Conclusion: Serum HMGB1, CTCs and AAPR are independently correlated with postoperative biochemical recurrence in patients with LRP. Serum HMGB1 combine with CTCs and AAPR has a high value in predicting postoperative biochemical recurrence in patients with LRP, and which may be an auxiliary predictor of postoperative biochemical recurrence in patients with LRP. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic radical prostatectomy has emerged as a minimally invasive alternative to open radical prostatectomy for the management of localized prostate cancer. Despite ongoing debates regarding their comparative benefits and drawbacks, comprehensive evaluations of perioperative and early postoperative outcomes are essential. Objectives: To compare perioperative and early postoperative outcomes between laparoscopic and open radical prostatectomy techniques in the management of localized prostate cancer. Methods: This single-center quasi-experimental study was initiated after approval in January 2015 from College of Medicine, Nursing, and Health Sciences Research Ethics committee with approval no: NN29. In two years, retrospective analysis of 66 case of laparoscopic group (LG) and 59 cases of open group (OG) of radical prostatectomy cases performed. Predefined criteria guided patient selection, and data were collected prospectively on perioperative factors. Statistical analyses were conducted to compare outcomes between the two surgical approaches. Consent was taken from participants. Results: Mean ages were LG 57.95±6.68 years and OG 60.13±5.45 years. Preoperative prostate-specific antigen levels were LG 6.68±2.78 ng/mL and OG 8.85±4.32 ng/mL. Distribution of preoperative grades differed between both groups. Mean operating times were LG 195.6 minutes±26.11 and OG 167.5 minutes±30.50. Blood loss averaged LG 406.6 mL±144.64 and OG 1057 mL±620.68. Postoperative stay durations were LG 4.94 days±2.91 and OG 6.46 days±1.93. Histological stages and grades varied postoperatively in both groups. Conclusion: Laparoscopic radical prostatectomy's advantages over open surgery for localized prostate cancer, citing reduced blood loss, shorter hospital stays, and quicker recovery. Despite longer operating times, laparoscopic cases demonstrate benefits, contributing to the debate on surgical approaches. [ABSTRACT FROM AUTHOR]

Objective: To observe the clinical efficacy of da vinci robot assist laparoscopic radical prostatectomy (RALRP), and to analyze the influencing factors of urinary control recovery after operation. Methods: 182 cases of laparoscopic radical prostatectomy who were admitted to Provincial Hospital Affiliated to Shandong First Medical University from March 2020 to January 2023 were selected as research objects, patients were divided into group A (n=81, traditional laparoscopic radical prostatectomy) and group B (n=101, RALRP) according to the different operation methods. The operation time, urinary control rate 1 month after operation, intraoperative blood loss, hospitalization time, catheter removal time, drainage tube removal time and incidence of complications after operation were recorded in two groups. For RALRP patients, the influencing factors of urinary control recovery after operation were analyzed by multivariate logistic regression analysis. Results: The operation time, drainage tube removal time, catheter removal time and hospitalization time in group B were shorter than those in group A, and the intraoperative blood loss was less than that in group A (P<0.05). The urinary control rate in group B was higher than that in group A 1 month after operation (P<0.05). The incidence of complications after operation in group B was lower than that in group A(P<0.05). Multivariate logistic regression analysis showed that, diabetes mellitus and history of transurethral resection of the prostate (TURP) were risk factors for urinary continence recovery after operation, while regular levator ani exercise and preservation of neurovascular bundle (NVB) were protective factors for urinary continence recovery after operation(P<0.05). Conclusions: RALRP in the treatment of patients with prostate cancer, which can shorten the operation time, drainage tube removal time, catheter removal time, hospitalization time, reduce intraoperative blood loss, improve the urinary control rate 1 month after operation and reduce the incidence of complications. In addition, diabetes mellitus, regular levator ani exercise, preservation of NVB and history of TURP are all influencing factors for short-term urinary continence recovery after RALRP, which is worthy of attention. [ABSTRACT FROM AUTHOR]

This meta‐analysis aims to comprehensively assess the impact of laparoscopic radical prostatectomy (LRP) on wound infection in patients with prostate cancer (PCa). A systematic search was conducted, from database inception to November 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) comparing LRP with open radical prostatectomy (ORP) in the treatment of PCa. Two researchers independently screened the literature, extracted data and conducted quality assessments based on pre‐defined inclusion and exclusion criteria. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs involving 1458 PCa patients were included. The analysis revealed the incidence of wound infection (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.16–0.51, p < 0.001) and complications (OR = 0.27, 95% CI = 0.20–0.37, p < 0.001) was significantly lower in the LRP group compared to the ORP group. This study demonstrates that LRP in PCa patients can effectively reduce the incidence of wound infections and complications, indicating significant therapeutic efficacy and justifying its broader clinical application. [ABSTRACT FROM AUTHOR]

Background Schwannomas originating in the prostate are extremely rare. We present a case of prostatic schwannoma in a 66‐year‐old male with lower urinary tract symptoms. Preoperative evaluation revealed a prostatic mass, and the definitive diagnosis was made through laparoscopic radical prostatectomy. Case presentation A 66‐year‐old male presented with persistent lower urinary tract symptoms for 5 years and a prostate‐specific antigen level of 0.63 ng/mL. MRI showed a well‐defined solid cystic mass in the posterolateral basal right peripheral zone, causing superior displacement of the right seminal vesicle. Laparoscopic radical prostatectomy was performed, confirming a periprostatic schwannoma. Conclusion This case highlights the rarity of prostatic schwannomas and their association with lower urinary tract symptoms. MRI plays a crucial role in identifying prostatic masses, while laparoscopic radical prostatectomy can serve as a diagnostic and therapeutic approach for prostatic schwannomas. Increased awareness of this rare entity is essential for accurate diagnosis and optimal management.

Abstract Background Prostate cancer (PCa) presents a wide spectrum. Systemic immune-inflammation index (SII) and Ki-67 index are new biomarkers that can predict prognosis in different types of cancer. We explored the predictive value of their combination on the prognosis of PCa patients after laparoscopic radical prostatectomy (LRP). Methods In this retrospective study, 290 patients who underwent LRP at Nanjing Lishui People’s Hospital between January 2016 and February 2021 were enrolled. They were divided into the good prognosis group (N = 235) and poor prognosis group (N = 55) based on the follow-up results. Both the baseline data and postoperative pathological results were collected. The Ki-67 index was determined using immunohistochemical kits, and the patients were allocated to the SII/Ki-67 index high/low expression groups according to the cut-off values to further analyze their relationship with clinical/pathological data of PCa patients. Logistics multivariate regression analysis was utilized to analyze the independent factors affecting post-LRP prognosis of CPa patients. ROC curve was plotted to assess the predictive value for post-LRP prognosis, and Kaplan-Meier curve/Log-rank were used for analysis. Results Significant differences were found in PSA/Gleason score/T stage/lymph node metastasis/seminal vesicle invasion/neutrophils/lymphocytes/platelets/preoperative SII/Ki-67 index between the good/poor prognosis groups. Preoperative SII/Ki-67 were related to PSA/lymphocytes/platelets in PCa. Seminal vesicle invasion and preoperative SII + Ki-67 index were independent factors affecting post-LRP prognosis. Preoperative SII + Ki-67 index had a better predictive value than preoperative SII or Ki-67 index alone. Patients with high preoperative SII and Ki-67 index levels had an increased risk of poor prognosis after LRP. Conclusion Preoperative SII + Ki-67 index had a better predictive value for poor prognosis after LRP than SII or Ki-67 index alone.

Background: Prostate cancer (PCa) presents a wide spectrum. Systemic immune-inflammation index (SII) and Ki-67 index are new biomarkers that can predict prognosis in different types of cancer. We explored the predictive value of their combination on the prognosis of PCa patients after laparoscopic radical prostatectomy (LRP). Methods: In this retrospective study, 290 patients who underwent LRP at Nanjing Lishui People's Hospital between January 2016 and February 2021 were enrolled. They were divided into the good prognosis group (N = 235) and poor prognosis group (N = 55) based on the follow-up results. Both the baseline data and postoperative pathological results were collected. The Ki-67 index was determined using immunohistochemical kits, and the patients were allocated to the SII/Ki-67 index high/low expression groups according to the cut-off values to further analyze their relationship with clinical/pathological data of PCa patients. Logistics multivariate regression analysis was utilized to analyze the independent factors affecting post-LRP prognosis of CPa patients. ROC curve was plotted to assess the predictive value for post-LRP prognosis, and Kaplan-Meier curve/Log-rank were used for analysis. Results: Significant differences were found in PSA/Gleason score/T stage/lymph node metastasis/seminal vesicle invasion/neutrophils/lymphocytes/platelets/preoperative SII/Ki-67 index between the good/poor prognosis groups. Preoperative SII/Ki-67 were related to PSA/lymphocytes/platelets in PCa. Seminal vesicle invasion and preoperative SII + Ki-67 index were independent factors affecting post-LRP prognosis. Preoperative SII + Ki-67 index had a better predictive value than preoperative SII or Ki-67 index alone. Patients with high preoperative SII and Ki-67 index levels had an increased risk of poor prognosis after LRP. Conclusion: Preoperative SII + Ki-67 index had a better predictive value for poor prognosis after LRP than SII or Ki-67 index alone. [ABSTRACT FROM AUTHOR]

In this study, we evaluated the association between the PPAT volume and the prognosis of PCa patients after LRP. We retrospectively analysed data of 189 PCa patients who underwent LRP in Beijing Chaoyang Hospital. Volumes of PPAT and prostate were measured by magnetic resonance imaging (MRI), and normalized PPAT volume was computed (PPAT volume divided by prostate volume). Patients were then stratified into the high-PPAT group (n = 95) and low-PPAT group (n = 94) by the median of normalized PPAT volume (73%). The high-PPAT group had significantly higher Gleason score (total score 8 or more, 39.0% vs. 4.3%, p < 0.001) and pathological stage (stage T3b, 28.4% vs. 13.8%, p = 0.048). No significant correlation between normalized PPAT volume and body mass index (ρ = −0.012, p = 0.872) was observed. Kaplan-Meier curve analysis showed the high-PPAT group had significantly shorter biochemical recurrence (BCR) interval (median progression-free survival time 15.9 months vs. 32.7 months, p = 0.001). Univiarate and multivariate Cox regression analyses showed high normalized PPAT volume (>73%) (hazard ratio 1.787 [1.075–3.156], p = 0.002) were independent risk factors for BCR post-operatively. In conclusion, MRI-measured PPAT volume is of significant prognostic value for PCa patients undergoing LRP. [ABSTRACT FROM AUTHOR]

Background: Positive surgical margins (PSM) is not only an independent risk factor for recurrence, metastasis, and prognosis, but also an important indicator of adjuvant therapy for prostate cancer (PCa) patients treated with radical prostatectomy (RP). At present, there are few reports analyzing risk factors of PSM in laparoscopic RP (LRP), especially for those PCa cases who accepted neoadjuvant hormonal therapy (NHT). Hence, the aim of the current study was to explore risk factors for PSM after LRP in PCa patients with and without NHT. Methods: The clinicopathological data of patients who underwent LRP from January 2012 to July 2020 was retrospectively analyzed. Risk factors for PSM after LRP in NHT and non-NHT groups were respectively explored. Results: The overall PSM rate was 33.3% (90/270), PSM rate was 39.3% (64/163) in patients without NHT and 24.3% (26/107) in those with NHT. The apex was the most common location of PSM in non-NHT group (68.8%, 44/64), while the fundus was the most common location of PSM in NHT group (57.7%, 15/26). Multiple logistic regression revealed that body mass index (BMI), PSA, ISUP grade after LRP, pathological stage T (pT) and pathological lymph node status (pN) were independent factors affecting the PSM for patients without NHT (OR=1.160, 95%CI:1.034-1.301, p=0.011; OR=3.385, 95%CI:1.386-8.268, p=0.007; OR=3.541, 95%CI:1.008-12.444, p=0.049; OR=4.577, 95%CI:2.163-9.686, p<0.001; OR=3.572, 95%CI:1.124-11.347, p=0.031), while pT, pN, and lymphovascular invasion (LVI) were independent risk factors affecting PSM for patients with NHT (OR=18.434, 95%CI:4.976-68.297, p<0.001; OR=7.181, 95%CI:2.089-24.689, p=0.002; OR=3.545, 95%CI:1.109-11.327, p=0.033). Conclusions: The apex was the most common location in NHT group, and BMI, PSA, ISUP after LRP, pT and pN were independent risk factors affecting PSM for NHT patients; while the fundus was the most common location in non-NHT group, and pT, pN, and LVI were independent risk factors affecting PSM for non-NHT patients. [ABSTRACT FROM AUTHOR]

ABSTRACTIn this study, we evaluated the association between the PPAT volume and the prognosis of PCa patients after LRP. We retrospectively analysed data of 189 PCa patients who underwent LRP in Beijing Chaoyang Hospital. Volumes of PPAT and prostate were measured by magnetic resonance imaging (MRI), and normalized PPAT volume was computed (PPAT volume divided by prostate volume). Patients were then stratified into the high-PPAT group (n = 95) and low-PPAT group (n = 94) by the median of normalized PPAT volume (73%). The high-PPAT group had significantly higher Gleason score (total score 8 or more, 39.0% vs. 4.3%, p 73%) (hazard ratio 1.787 [1.075–3.156], p = 0.002) were independent risk factors for BCR post-operatively. In conclusion, MRI-measured PPAT volume is of significant prognostic value for PCa patients undergoing LRP.

Prostatic abscess (PA) prevalence has decreased in the era of antibiotics. This condition is associated with chronic conditions, including diabetes, immunodeficiency, liver disease, or even severe diseases such as prostate cancer. Concomitant prostatic abscess and prostate cancer are very challenging to treat because of the lack of specific guidelines, significant complications, and controversial treatment approaches. By reporting a case with prostate cancer in the setting of a prostatic abscess treated successfully by surgery, we propose a 2-steps approach including transurethral resection drainage followed by laparoscopic radical prostatectomy.

Prostate cancer (PCa) surgery has a strong impact on men's social and sexual lives. For this reason, many patients ask for robotic surgery. To assess the rate of lost patients due to the lack of a robotic platform (RPl) at our center, we retrospectively selected 577 patients who underwent prostate biopsy between 2020 and 2021 who were eligible for radical prostatectomy (RP) (ISUP ≥ 2; age ≤ 70 yr). Patients eligible for surgery who decided to be operated received a phone call interview asking the reason for their choice. Overall, 230 patients (31.7%) underwent laparoscopic-assisted radical prostatectomy (LaRP) at our center, while 494 patients (68.3%) were not treated in our hospital. Finally, 347 patients were included: 87 patients (25.1%) underwent radiotherapy; 59 patients (17%) were already under another urologist's care; 113 patients (32.5%) underwent robotic surgery elsewhere; and 88 patients (25.4%) followed the suggestion of friends or relatives based on their surgical experience. Despite no surgical technique for RP having shown superiority in terms of oncological or functional outcomes, patients eligible for PCa treatment decided to be operated on elsewhere because of the lack of an RPl. Our results show how the presence of an RPl may increase the case volume of RP by 49% at our center. [ABSTRACT FROM AUTHOR]

Introduction/Objective. Radical prostatectomy (RP) is a treatment option with high curative potential in patients with prostate cancer of moderate-risk. The aim of the study is to assess perioperative results of laparoscopic RP (LRP) and open retropubic RP (ORRP). Methods. From 2016 to 2020, a total of 244 patients undergone RP, as follow: 145 patients LRP and 99 patients ORRP. Demographic data, preoperative parameters, perioperative and pathological outcomes were analyzed and compared among LRP and ORRP groups. Results. In regard to demographic data and preoperative parameters (BMI, mean age, median pretreatment prostate-specific antigen, clinical stage and Gleason score from biopsy), there are no differences between the observed groups. Patients from ORRP group had significantly shorter operative time (p < 0.05). Patients from LRP group had major advantages in regard to estimated blood loss (EBL) (550 ml for LRP vs. 1450 ml for ORRP), hospitalization time (six days for LRP vs. nine days for ORRP), catheter removal (6.5 days for LRP vs. 12 days for ORRP), overall complication rates (29% for LRP vs. 48.4% for ORRP) and blood transfusion rates (22.7% for LRP and 37.4% for ORRP). Conclusion. Both LRP and ORRP provide favorable operative results in terms of efficacy, safety and oncologic outcome. However, patients undergoing LRP were more likely to have less EBL, shorter length of hospital stay, earlier catheter removal and lower rates of overall perioperative complications.

Objective: To analyze the perioperative outcomes of neoadjuvant hormone therapy (NHT) before laparoscopic and robot-assisted surgery for localized high-risk prostate cancer in a Chinese cohort. Methods: The clinical data of 385 patients with localized high-risk prostate cancer who underwent radical prostatectomy (RP) in our hospital from January 2019 to June 2021 were analyzed retrospectively, including 168 patients with preoperative NHT and 217 patients with simple surgery. Clinical characteristics were compared in the above two groups, the laparoscopic RP (LRP) cohort (n = 234) and the robot-assisted laparoscopic radical prostatectomy (RALP) cohort (n = 151), respectively. Results: In the overall cohort, compared with the control group, the NHT group had a shorter operative time, less blood loss, a lower positive surgical margin rate, and a higher proportion of Gleason score (GS) downgrading after the operation (p < 0.05). However, there was no significant difference in hospitalization time, biochemical recurrence, urine leakage, urinary continence, or prostate-specific antigen (PSA) progression-free survival (p > 0.05). In the LRP cohort, it was found that the NHT group also had shorter operative time, less blood loss, lower positive surgical margin rate, a higher proportion of GS downgrading after the operation, and faster recovery of urinary control than the control group (p < 0.05). There was no marked difference in hospitalization time, biochemical recurrence, urinary leakage, or PSA progression-free survival. However, in the RALP cohort, the NHT group had a significant difference in the GS downgrading after the operation compared with the control group (p < 0.05). In the overall cohort, multiple analyses showed that initial PSA level, GS at biopsy, clinical T stage, lymph node invasion, use of NHT, and surgical methods were significantly associated with positive surgical margin (p < 0.05) while NHT did not account for biochemical recurrence (p > 0.05). Conclusions: NHT can lower the difficulty of surgery, reduce positive surgical margin rate, and help recovery in short-term urinary control in patients with high-risk prostate cancer after LRP. However, we do not have evidence on the benefit of NHT in high-risk PCa patients treated with RALP. For these patients, surgery can be performed as early as possible.

Objective: To analyze the predictive value of serum testosterone combined with red blood cell distribution width (RDW) and albumin alkaline phosphatase ratio (AAPR) for biochemical recurrence after laparoscopic radical prostatectomy (LRP) .Methods: 90 prostate cancer (PCa) patients who were treated with LRP in Hainan Provincial People’s Hospital from January 2017 to January 2019 were selected, and they were divided into biochemical recurrence group (n=34) and non biochemical recurrence group (n=56) according to whether biochemical recurrence occurred after LRP. The basic data of PCa patients were collected, and the serum levels of testosterone, RDW and aapr were measured before operation. Multivariate Cox regression was used to analyze the influencing factors of biochemical recurrence after LRP, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum testosterone, RDW and AAPR for biochemical recurrence after LRP. Results: Following up for 3 years, 34 cases of 90 PCa patients had biochemical recurrence after LRP, and the biochemical recurrence rate was 37.78%. Univariate analysis showed that biochemical recurrence group was related to age, PSA, Gleason score, pathological stage, testosterone, AAPR and RDW (P <0.05) .Multivariate Cox regression analysis showed that age increase, PSA > 20 ng/mL, Gleason score of 8 scores, pathological stage pT3and RDW increase were independent risk factors for biochemical recurrence after LRP, and testosterone increase and AAPR increase were independent protective factors (P<0.05) . ROC curve analysis showed that the area under curve (AUC) of serum testosterone, RDW and AAPR alone and combination in predicting biochemical recurrence after LRP were 0.771, 0.754, 0.772 and 0.922, respectively, the AUC of biochemical recurrence after LRP predicted by the three combined factors was greater than that predicted by alone (P <0.05) .Conclusion: The increase of RDW is a risk factor for biochemical recurrence after LRP and the increase of serum testosterone and aapr are protective factors, and which can be used as an auxiliary predictor of biochemical recurrence after LRP. The combination of serum testosterone, RDW and AAPR has a high value in predicting biochemical recurrence after LRP. [ABSTRACT FROM AUTHOR]

Objectives: To compare the therapeutic features and oncological outcomes of robot-assisted radical prostatectomy (RARP) with those of open radical prostatectomy (ORP) or laparoscopic radical prostatectomy (LRP) in lymph node (LN) positive prostate cancer patients in a retrospective observational multi-institutional study. Patients and methods: We evaluated the clinical results of 561 patients across 33 institutions who underwent RARP, LRP, or ORP and who were diagnosed with LN-positive prostate cancer during RP with pelvic LN dissection (PLND). We determined the following survival outcomes: metastasis-free survival, overall survival, cancer-specific survival, and biochemical recurrence-free survival. The Kaplan–Meier method, log-rank test, and Cox proportional hazards regression model were used to evaluate the effect of treatment on oncological outcomes. Statistical significance was set at P < 0.05. Results: There was no significant difference for any of the survival outcomes between the three surgical groups. However, RARP achieved a greater LN yield compared to that of ORP or LRP. When the extent of PLND was limited to the obturator LNs, the number of removed LNs (RLNs) was comparable between the three surgical groups. However, higher numbers of RLNs were achieved with RARP compared to the number of RLNs with ORP (P < 0.001) when PLND was extended to the external and/or internal iliac LNs. Conclusion: RARP, LRP, and ORP provided equal surgical outcomes for pN1 prostate cancer, and the prognosis was relatively good for all procedures. Increased numbers of RLNs may not necessarily affect the oncological outcome. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical efficacy of neoadjuvant chemohormonal therapy (NCHT) combined with laparoscopic radical prostatectomy in high-risk prostate cancer (PCa). Methods: A randomized controlled trial was used in this study. Eighty patients with high-risk PCa treated in Tangshan Gongren Hospital from January 2017 to January 2019 were selected and randomly divided into two groups. The control group was given neoadjuvant endocrine therapy, while the research group was added NCHT to the control group. Three months later, the patients of two groups underwent laparoscopic radical prostatectomy. The changes of surgical indicators, adverse drug reactions, incidence of lower urinary tract symptoms, biochemical recurrence rate after follow-up, PSA progression-free survival and incidence of surgical complications were compared between the two groups. Results: After NCHT, the PSA level and prostate volume in the research group decreased significantly than those in the control group (P = 0.00). Surgical duration, postoperative hospital stay and retention time of drainage tube were significantly shorter and intraoperative blood loss was significantly less in the research group than those in the control group (P = 0.00). The incidence of lower urinary tract symptoms, biochemical recurrence and surgical complications in the research group were significantly lower than those in the control group, and the early recovery rate of urinary control and progression-free survival were significantly better than those in the control group (P < 0.05). Conclusion: NCHT combined with laparoscopic radical prostatectomy is a safe and effective treatment for high-risk PCa, which is worthy of promotion in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose of the study. To evaluate the effectiveness of preserving the anatomical structures surrounding the prostate gland for prophylactic intraoperative restoration of urinary retention functions in the postoperative period. Materials and methods. A study was carried out in 86 patients with prostate cancer after performing radical prostatectomy from 2013 to 2021. Men were divided into 4 groups: Group 1 – LRP with preservation of the puboprostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis. Group 2 – LRP with complete preservation of the anatomical structures of the small pelvis without preserving the neurovascular bundles of the penis. Group 3 – ORP with preservation of the puboprostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis. Group 4 – RRP with complete preservation of the anatomical structures of the small pelvis without preserving the neurovascular bundles of the penis. In group 1, in which LRP was performed, 58 patients with prostate cancer T1N0M0 and T2N0M0. In group 2 LRP 12 patients with prostate cancer T1N0M0 and T2N0M0. There were 12 patients with prostate cancer T1N0M0 and T2N0M0 in group 3 with RRP. There are 4 patients with prostate cancer T1N0M0 and T2N0M0 in group 4 with RRP. He diagnosis of prostate cancer in all patients was established on the basis of a histological examination of preparations obtained by performing a transrectal multifaceted biopsy of the prostate gland. The basis for performing a biopsy was an increase in the level of prostate-specific antigen (PSA) in the blood above 4 ng/ml, the presence of pathological nodes according to MRI of the pelvic organs with contrast, as well as suspicious areas of the prostate gland during digital rectal examination. A study was carried out in 86 patients with prostate cancer after performing radical prostatectomy from 2013 to 2021. Research results and their discussion. 12 patients of group 3 underwent open surgery-radical prostatectomy. RRP (12 people) with preservation of the pubo-prostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis. In 4 patients of group 4, RRP with complete preservation of the anatomical structures of the small pelvis without preservation of the neurovascular bundles of the penis. We do not dwell on the method of performing the operation, it is known, all 16 patients underwent lymphadenectomy. The average operation time in the groups LRP 1 group, LRP 2 group did not differ significantly, and amounted to 147,16. And in a comparative analysis in group 3 RR, Group 4 RR there was a difference of 89,29, open operations were performed much faster. In our study, the criterion for urinary retention was the absence of the patient's need to use safety pads. This definition is adhered to by many specialists involved in the surgical treatment of prostate cancer. The use of at least 1 safety pad was equivalent to urinary incontinence. And it was considered a complication after the operations performed. Inourstudy, themeantimetorestoration of the full urinary continence function was the longest where the standard surgical procedure was performed, and the shortest was in the groups where the maximum preservation of the anatomical structures of the periprostatic anatomical zone was performed. Conclusions. 1. The main mechanism for the rapid restoration of urinary retention in patients after radical prostatectomy with prostate cancer is the maximum preservation of the pubo-prostatic ligaments and the pubo-perineal muscle, which makes it possible to fully restore the function of urinary retention within a month. 2. Preservation, only of the neurovascular bundle of the penis, is not enough to restore the function of early urinary retention after surgery.

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Background: Positive surgical margins (PSMs) are an independent risk factor of biochemical recurrence in patients with prostate cancer (PCa) after laparoscopic radical prostatectomy; however, limited MRI-based predictive tools are available. This study aimed to develop a novel nomogram combining clinical and multiparametric MRI (mpMRI) parameters to reduce PSMs by improving surgical planning. Methods: One hundred and three patients with PCa (55 patients with negative surgical margins [NSMs] and 48 patients with PSMs) were included in this retrospective study. The following parameters were obtained using GE Functool post-processing software: diffusion-weighted imaging (DWI); intravoxel incoherent motion model (IVIM); and diffusion kurtosis imaging (DKI). Patients were divided into different training sets and testing sets for different targets according to a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) regression algorithm was used to analyze the data set to select the optimal MRI predictors. Preoperatively clinical parameters used to build a clinical nomogram (C-nomogram). Multivariable logistic regression analysis was used to build an MRI nomogram (M-nomogram) by introducing the MRI parameters. Based on the MRI and clinical parameters, build an MRI combined with clinical parameters nomogram (MC-nomogram). Comparisons with the M-nomogram and MC-nomogram were based on discrimination, calibration, and decision curve analysis (DCA). A 3-fold crossvalidation method was used to assess the stability of the nomogram. Results: There was no statistical difference in AUC between the C-nomogram (sensitivity=64%, specificity=65% and AUC=0.683), the M-nomogram (sensitivity=57%, specificity=88% and AUC=0.735) and the MCnomogram (sensitivity= 64%, specificity=82% and AUC=0.756). The calibration curves of the three nomograms used to predict the risk of PSMs in patients with PCa showed good agreement. The net benefit of the MCnomogram was higher than the others (range, 0.2-0.7). Conclusions: The mpMRI-based nomogram can predict PSMs in PCa patients. Although its AUC (0.735) is not statistically different from that of the clinicalbased nomogram AUC (0.683). However, mpMRI-based nomogram has higher specificity (88% VS. 63%), model stability, and clinical benefit than clinicalbased nomogram. And the predictive ability of mpMRI plus clinical parameters for PSMs is further improved. [ABSTRACT FROM AUTHOR]

Abstract Background Although open radical prostatectomy has been used in the treatment of localized prostate cancer for a long time, minimally invasive surgical approaches such as laparoscopic radical prostatectomy and robot-assisted radical prostatectomy have recently gained importance in order to improve postoperative results and shorten hospital stay. Although the enhanced recovery after surgery (ERAS) protocol was first defined for gastrointestinal surgeries in 2001, it has now been used in gynecological, orthopedic, thoracic and urological surgeries. In our study, we aimed to compare the results of the ERAS protocol with the conventional approach in patients who underwent laparoscopic radical prostatectomy. Methods There is a retrospective analysis of 70 patients who underwent laparoscopic radical prostatectomy at Kayseri City Hospital between May 2018 and January 2021. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS, Armonk, NY, USA). Seventy patients were included in the study. While 48 patients who underwent perioperative care with the traditional approach were included in the conventional group, 22 patients were included in the ERAS group. Age, comorbidities, preoperative PSA level, digital rectal examination findings, preoperative imaging, extra prostatic spread and lymph node involvement, location of tumors, time between biopsy and surgery, lymphadenectomy status, and histopathological findings of transrectal ultrasound biopsy and prostatectomy specimens were recorded for each patient. Initiation of enteral feeding, time to first defecation, duration of antibiotic use, ileus development rate and length of hospital stay (LOS) were compared for both groups. Results The mean age of 48 patients in the conventional group was 63.37 ± 7.01 years, while the mean age of 22 patients in the ERAS group was 66.36 ± 5.31 years (p = 0.080). Although the first defecation time was shorter in the ERAS group (4.75 ± 3.21 vs. 3.73 ± 2.12 days, p = 0.179), there was no statistically significant difference. Ileus developed in 10 (20.8%) patients in the conventional group and 2 (9.1%) in the ERAS group. Use of antibiotics in the postoperative period in the conventional group (5.83 ± 3.62 vs. 3.18 ± 2.42 days, p = 0.003) and LOS (7.92 ± 3.26 vs. 5.91 ± 2, 15 days, p = 0.011) were statistically significantly longer. Conclusion In summary, ERAS protocol is associated with short LOS, time to initiation of enteral feeding and duration of antibiotics use. There was no statistically significant difference in the rate of ileus and time to first defecation between the two groups. Randomized prospective studies on heterogeneous and larger patient groups are needed to confirm our findings.

Introduction: Radical prostatectomy (RP) is the standard surgical treatment for localized prostate cancer (PCa), with excellent oncologic outcomes; however, complications such as post-prostatectomy incontinence could significantly affect quality of life. Aim: To provide data on long-term urinary functional outcomes of bladder neck preservation (BNP) combined with distal urethral length preservation (DULP) in patients treated with videolaparoscopic prostatectomy. Material and methods: In this retrospective study, data were analysed from 619 consecutive patients who underwent laparoscopic radical prostatectomy (LRP) due to localized prostate cancer between November 2014 and December 2018 in a single tertiary care centre in Poland. Of these patients, 227 had BNP and DULP during the procedure. Urinary continence status was assessed in patients at 3, 6, 12, and 18 months after LRP. Cancer resection was assessed by surgical margin status. Results: In the group with BNP and DULP, urinary continence recurred earlier than it did in the control group up to 3 months after surgery: 204 (89.8%) patients in this group were fully continent compared with 283 (72.2%) in the control group (p < 0.001). The difference was also significant after 6 months (95.1% vs. 80.6%, respectively; p < 0.001). Despite these early promising results, there was no difference in urinary continence recovery after 12 and 18 months. There was also no difference between the 2 groups regarding surgical margin status of the resected tissue. Conclusions: Our study showed that BNP combined with DULP is a safe procedure that helps to improve early urinary continence rates after surgery without altering the risk of positive surgical margin. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to evaluate the risk factors for lower urinary tract symptoms in prostate cancer patients underwent radical prostatectomy, thus providing therapeutic evidence for post‐operative nursing. Background: Prostate cancer is one of the most commonly diagnosed male malignancy in recent years. With surgical treatments, patients with prostate cancer indeed have satisfying survival rate. However, the presence of postprostatectomy lower urinary tract symptoms which affect quality of life significantly is more worthy of attention. Design: Patients underwent surgical therapies were followed up and the symptoms were recorded. Methods: A total of 65 prostate cancer patients underwent radical prostatectomy from January 2019 to October 2020, and pathologically diagnosed with prostate cancer were enrolled in our study. These patients were followed up 3 months after surgery and their medical records were retrospectively collected and analysed. Results were reported according to the STROBE Statement. Results: The incidence of post‐operative lower urinary tract symptoms at 3 months after surgery is similar to that of pre‐operation. Univariate and multivariate analyses revealed that the independent risk factor for postprostatectomy lower urinary tract symptoms is body mass index, whereas pelvic floor muscle exercise is a protective factor. Conclusions: The incidence of postprostatectomy lower urinary tract symptoms is non‐negligible, which significantly affects quality of life. Body mass index is found as an independent risk factor for postprostatectomy lower urinary tract symptoms, while pelvic floor muscle exercise is a strong protector. Relevance to clinical practice: Patients with prostate cancer would benefit from post‐operative pelvic floor muscle exercise. These findings contribute to tailor post‐operative nursing strategy. [ABSTRACT FROM AUTHOR]

PurposeSince there was no consensus on treatment options for localized prostate cancer, we performed a retrospective study to compare the long-term survival benefit of radiotherapy (RT) versus laparoscopic radical prostatectomy (LRP) in Taiwan.Methods218 patients with clinically localized prostate cancer treated between 2008 and 2017 (64 with LRP and 154 with RT) were enrolled in this study. The outcomes of RT and LRP were assessed after patients were stratified according to Gleason score, stage, and risk group. Crude survival, prostate cancer-specific survival, and metastasis-free survival were evaluated using the log-rank test.ResultsThe 5-year crude survival rate was 93.3% in the LRP group and 59.3% in the RT group. A significant survival benefit was found in the LRP group compared with the RT group (p = 0.004). Furthermore, significant differences were found in disease-specific survival (93.3% vs. 64.7%, p = 0.022) and metastasis-free survival (48% vs. 40.2%, p = 0.045) between the LRP and RT groups.ConclusionsMen with localized prostate cancer treated initially with LRP had a lower risk of prostate cancer-specific death and metastases compared with those treated with RT.

Yong Liu,1,2 Qinxin Zhao,3 Feiya Yang,3 Mingshuai Wang,1 Nianzeng Xing1,3 1Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People’s Republic of China; 2Department of Urology, Weihai Municipal Hospital, Weihai, 264200, People’s Republic of China; 3Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of ChinaCorrespondence: Nianzeng XingDepartment of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan South Li, Chaoyang, Beijing, 100021, People’s Republic of ChinaEmail xingnianzeng@126.comBackground: Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the “Sandwich” urethra reconstruction technique on continence at the early stage after LRP.Methods: During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the “Sandwich” technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated.Results: There is no statistical difference in patients’ basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49± 4.72 minutes in Group A and 20.16± 5.75 minutes in Group B (P< 0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B (P< 0.001). Maximum flow rates before and after the “Sandwich” procedure for 12 months were 13.2± 2.8 m/s and 15.4± 3.6 m/s, respectively (P=0.034). In addition, residual volumes before and after the “Sandwich” procedure for 12 months were 15 (0– 20) mL and 0 (0– 12.5) mL, respectively (P=0.107).Conclusion: Our prospective study confirms that the “Sandwich” technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.Keywords: Sandwich, urethral reconstruction, laparoscopic radical prostatectomy, urinary incontinence, urodynamic tests

Abstract Background To compare the functional and oncological outcomes between innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy (LRP) in patients with prostate cancer (PCa). Methods We retrospectively collected the data of PCa patients treated at our institutions from June 2012 to May 2016. According to the inclusion criteria, a total of 234 patients were included in the study, including 112 in group A (four-port) and 122 in group B (three-port). The perioperatively surgical characteristics, functional and oncological outcomes were compared between groups. Results There were no statistical differences in the baseline parameters between these two groups. Compared with group A, the operative time (OT) and estimated blood loss (EBL) were significantly less in group B. On follow-up, the rate of positive surgical margin (PSM), prostate specific antigen (PSA) biochemical recurrence and continence after LRP did not show any statistically significant difference between the groups. An identical conclusion was also received in comparison of overall survival (OS) and biochemical recurrence-free survival (BRFS) between both groups. Conclusions Innovative “three-port” LRP can significantly shorten the OT and reduce the EBL compared with the traditional “four-port” LRP. Meanwhile, it does not increase the rate of PSM and PSA biochemical recurrence. “Three-port” LRP could be popularized in the future in view of its superior surgical technique, considerably better functional outcomes and remarkable oncological control.

Objectives: There is no recommended observation time for patients who have undergone radical prostatectomy for prostate cancer. This study was undertaken to determine the postoperative observation time by investigating the hazard rate for prostate‐specific antigen failure and other‐cause death using Weibull analysis. Methods: We included 612 patients who underwent laparoscopic radical prostatectomy for localized prostate cancer between June 2002 and December 2017. Risk classification was categorized by the D'Amico risk classification, and the patients were divided into three age groups: <60, 60–69 and ≥70 years. The hazard rates at each point were derived using Weibull analysis. The optimal observation time after laparoscopic radical prostatectomy was determined as the intersection point at which the hazard rate of other‐cause death overtakes the hazard rate of prostate‐specific antigen failure. Results: In all groups classified by age, the hazard rate of other‐cause deaths increased over time. In contrast, the hazard rate of prostate‐specific antigen failure decreased gradually. The ≥70 years age group showed the highest hazard rate. The hazard rate of prostate‐specific antigen failure was highest in the high‐risk group. The patients aged ≥70 and 60–69 years in the low‐risk group were recommended 6 years 6 months and 14 years 8 months, respectively, for observation. The remaining patients were recommended >25 years of postsurgical observation. Conclusions: The observation time after laparoscopic radical prostatectomy could be estimated by comparing the estimated hazard rates of prostate‐specific antigen failure and other‐cause death based on Weibull analysis. Urologists should pay attention to age and risk classifications for optimal postoperative observation. [ABSTRACT FROM AUTHOR]

Introduction: The quality of vesicourethral anastomosis (VUA) in laparoscopic radical prostatectomy (LRP) is associated with complications that could significantly affect quality of life. Aim: To compare different types of sutures (Chlosta's versus Van Velthoven versus V-Loc), used for VUA in LRP in terms of complication rates and continence recovery. Material and methods: Patients who underwent LRP between 2014 and 2018 in a tertiary center were enrolled in the study. Data were extracted from medical records. Urinary continence was assessed at 3, 6, 12 and 18 months after LRP. Propensity score weighted regression models were used to estimate the effect of sutures on outcomes. Results: A sample of 504 patients was analyzed, of which 109 patients underwent Chlosta's suture VUA, 117 patients had Van Velthoven suture VUA, and 278 patients had V-Loc VUA. Median time of anastomosis was 13 (IQR - interquartile range: 10-16) min using Chlosta's suture, 28 (IQR: 24-30) using Van-Velthoven suture and 12 (IQR: 11-16) min using V-Loc suture (p < 0.001). There were no significant differences between groups concerning complications and urinary continence at 12 and 18 months after surgery. The time of urinary continence recovery was on average 19 days (95% CI: 5-33) and 31 days (95% CI: 16-45) shorter during 1 year of observation when the V-Loc suture was used compared to the Van-Velthoven and Chlosta's suture, respectively. Conclusions: The study showed comparable results considering urinary continence recovery at 12 and 18 months after LRP in all VUA groups. Van Velthoven VUA was more time-consuming and continence recovery was faster in the V-Loc group. [ABSTRACT FROM AUTHOR]

Purpose: To provide a systematic analysis of the comparative outcomes of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) in the treatment of prostate cancer based on the best currently available evidence. Methods: An independent systematic review of the literature was performed up to February 2021, using MEDLINE®, EMBASE®, and Web of Science® databases. Preferred reporting items for systematic review and meta-analysis (PRISMA) recommendations were followed to design search strategies, selection criteria, and evidence reports. The quality of the included studies was determined using the Newcastle–Ottawa scale for non-randomized controlled trials. Demographics and clinical characteristics, surgical, pathological, and functional outcomes were collected. Results: Twenty-six studies were identified. Only 16 "high-quality" (RCTs and Newcastle–Ottawa scale 8–9) studies were included in the meta-analysis. Among the 13,752 patients included, 6135 (44.6%) and 7617 (55.4%) were RARP and LRP, respectively. There was no difference between groups in terms of demographics and clinical characteristics. Overall and major complication (Clavien–Dindo ≥ III) rates were similar in LRP than RARP group. The biochemical recurrence (BCR) rate at 12months was significantly lower for RARP (OR: 0.52; 95% CI 0.43–0.63; p < 0.00001). RARP reported lower urinary incontinence rate at 12months (OR: 0.38; 95% CI 0.18–0.8; p = 0.01). The erectile function recovery rate at 12months was higher for RARP (OR: 2.16; 95% CI 1.23–3.78; p = 0.007). Conclusion: Current evidence shows that RARP offers favorable outcomes compared with LRP, including higher potency and continence rates, and less likelihood of BCR. An assessment of longer-term outcomes is lacking, and higher cost remains a concern of robotic versus laparoscopic prostate cancer surgery. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the feasibility, safety and advantages of Laparo-Endoscopic Single-site Surgery radical prostatectomy (LESS-RP) based on our personal experience. Patients and methods: Details of 520 patients were retrospectively analyzed, from 2009 to 2019. Extraperitoneal approach, with only two accesses (2.5 cm and 5 mm respectively) was used to perform radical prostatectomy. Perioperative characteristics and postoperative oncologic and functional outcomes are reported. Results: The mean age was 66.6 ± 5.6 years. Mean PSA level was 9 ± 3.5 ng/ml. According to D'Amico classification, the percentage of patients with low-, intermediate-, and high-risk disease cases were 116 (22.4%), 275 (52.8%), and 129 (24.8%) respectively. Mean operative time was 156 ± 43 min. Mean estimated blood loss was 214 ± 93 ml. Positive surgical margins (PSMs) were detected in 110 (21.2%) patients. PSM rates in pT2 and pT3 stages were 20.1% and 22.9%, respectively. The overall complication rate was 9.2%, based on the modified Clavien classification. The 12 months continence and potency rates were 90.9% and 49.1%, respectively. The biochemical recurrence rate was 6.8%, at the median follow-up time of 26.7 months (IQR 12–32). Conclusions: Our analyses show that LESS-RP is a safe procedure, if performed by surgeons with adequate experience and skills. Unlike the classic laparoscopic prostatectomy, this technique allows better aesthetic and psychological results, reduced postoperative pain, and a faster return to normal daily activity with the same functional and oncological results. [ABSTRACT FROM AUTHOR]

Background: To compare the functional and oncological outcomes between innovative "three-port" and traditional "four-port" laparoscopic radical prostatectomy (LRP) in patients with prostate cancer (PCa).Methods: We retrospectively collected the data of PCa patients treated at our institutions from June 2012 to May 2016. According to the inclusion criteria, a total of 234 patients were included in the study, including 112 in group A (four-port) and 122 in group B (three-port). The perioperatively surgical characteristics, functional and oncological outcomes were compared between groups.Results: There were no statistical differences in the baseline parameters between these two groups. Compared with group A, the operative time (OT) and estimated blood loss (EBL) were significantly less in group B. On follow-up, the rate of positive surgical margin (PSM), prostate specific antigen (PSA) biochemical recurrence and continence after LRP did not show any statistically significant difference between the groups. An identical conclusion was also received in comparison of overall survival (OS) and biochemical recurrence-free survival (BRFS) between both groups.Conclusions: Innovative "three-port" LRP can significantly shorten the OT and reduce the EBL compared with the traditional "four-port" LRP. Meanwhile, it does not increase the rate of PSM and PSA biochemical recurrence. "Three-port" LRP could be popularized in the future in view of its superior surgical technique, considerably better functional outcomes and remarkable oncological control. [ABSTRACT FROM AUTHOR]

Sparing of puboprostatic ligaments (PPLs) during radical prostatectomy was introduced as a technique to improve urinary continence. This study aims to study the effect of sparing of PPLs during laparoscopic radical prostatectomy in terms of continence during the first 3 months. A total of 74 patients, diagnosed with clinically localized prostate cancer, were randomly assigned to two equal groups; PPLs division and sparing during LRP. Based on the number of daily used pads, both groups completed 3 months follow-up to assess continence recovery. The effects of age, preoperative total prostate-specific antigen (PSA) and clinical tumor stage on continence recovery were also studied. The study was registered and approved by the Ethics Committee of Alexandria University-Faculty of Medicine (Protocol No. 0201074). Seventy-four patients were enrolled, with a mean age of 63.8 years. Baseline characteristics were comparable, except significantly higher mean PSA in the division group. Sixty patients were continent (0–1 pad/day) at 3 months follow-up. Continence was significantly better in the sparing than division group at 1 week after catheter removal (67.6% vs 40.5%, p = 0.01), at 1 month (73% vs 45.9%, p = 0.009) and 2 months (89.2% vs 51.4%, p = 0.0001). At 3 months follow-up, there was no significant difference between both groups (83.3% vs 78.4% for sparing and division groups, respectively; p = 0.28). Moreover, continence was significantly improved at 3 months compared to 1 week in both groups. Sparing of puboprostatic ligaments during radical prostatectomy significantly improves postoperative early recovery of urinary continence. [ABSTRACT FROM AUTHOR]

Background: Controlling Nutritional Status (CONUT) score was used for screening the preoperative nutritional status. The correlation between the CONUT score and the prognosis of patients with prostate cancer (PCa) has yet to be elucidated. Herein, we analyzed the prognostic value of CONUT scores in patients with PCa who underwent laparoscopic radical prostatectomy., Materials and Methods: Data of 244 patients were retrospectively evaluated. Perioperative variables and follow-up data were analyzed. The patients were categorized into 2 groups according to their preoperative CONUT scores. Postoperative complication and incontinence rates were also compared. The Kaplan-Meier method was used to estimate the median biochemical recurrence-free survival (BCRFS) between the 2 groups. Univariate and multivariate Cox regression analyses were performed to identify the potential prognostic factors for BCRFS., Results: Patients were categorized into the low-CONUT group (CONUT score <3, n = 207) and high-CONUT group (CONUT score ≥3, n = 37). The high-CONUT group had a higher overall complication rate (40.5% vs.19.3%, p = 0.004), a higher major complication rate (10.8% vs. 3.9%, p = 0.013), and longer postoperative length of stay (8 days vs. 7 days, p = 0.017). More fever, urinary infection, abdominal infection, scrotal edema, rash, and hemorrhagic events (all p values < 0.05) were observed in the high-CONUT group. A higher rate of urinary incontinence was observed in the high-CONUT group at 1 (34.4% vs. 13.2%, p = 0.030) and 3 months (24.1% vs. 8.2%, p = 0.023) postoperatively. The high-CONUT group had shorter medium BCRFS (23.8 months vs. 54.6 months, p = 0.029), and a CONUT score ≥3 was an independent risk factor for a shorter BCRFS (hazards ratio, 1.842; p = 0.026)., Conclusions: The CONUT score is a useful predictive tool for higher postoperative complication rates and shorter BCRFS in patients with PCa who undergo laparoscopic radical prostatectomy., Competing Interests: YN is an editorial board member of Current Urology. This article was accepted after a normal external review. No conflict of interest has been declared by the other authors., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc.)

Background Management of high risk prostate cancer (HRPC) is in evolving stage. Effectiveness of the various treatment strategies is being explored. We examined the short term efficacy of laparoscopic radical prostatectomy (LRP) in treatment of patients with HRPC. Methods Retrospective observational study had 140 HRPC patients of Indian origin, based on D’Amico classification system. Baseline workup was completed. Perioperative parameters and pathological findings were recorded. Multivariate analysis was performed to find predictive factors of pathological stage and PSM. 5 year biochemical recurrence free survival (BCRFS), cancer specific survival (CSS) and overall survival (OS) were calculated. Results Mean age and PSA were 67.24±7.37 years and 23.29 ng/ml respectively. Three fourth of patients had a biopsy GS ≥8. 53.6% of patients were of clinical stage (CS) ≤T2; while 46.4% were of stage ≥T3. Conversion to open surgery rate was 15%. Mean operative time was 210 minutes; blood loss 230 ml; hospital stay 3 days; catheterization time 14 days; grade II or more complication rate 22.1%; LN positivity 20.0%; PSM rate 25.7%; upstaging 35.7%; down-staging 14.3%; pT2 31.4%; pT3a 26.4%; pT3b 42.2%. GS and CS were predictive of pathological stage and PSM respectively. 89.3% of cases were continent postoperatively. 5 year BCRFS, CSS and OS were 68.3%, 89.2% and 78.7% respectively. Conclusions LRP is feasible and effective initial treatment for HRPC. Perioperative morbidity is acceptable. Accurate staging helps in better planning of the adjuvant therapy. Good short term survival can be achieved with multimodal therapy.

Laparoscopic (including robot-assisted) radical prostatectomy has become an alternative to open radical retropubic surgery. The main surgical techniques for reducing the period of urinary incontinence after radical prostatectomy are aimed at preserving, reconstructing and strengthening the structures that provide a complex mechanism for urine retention, namely, the pubo-prostate-vesicular ligaments, bladder neck, Denonvilliers` fascia, in procuring the functional length of the urethra, etc. Despite advances in the study of urinary continence mechanism there exists a large number of problems that need to be discussed. Therefore, researchers continue to search for solutions to create an optimal technique that ensures the earliest possible of urine retention, which is one of the main tasks in the social and medical rehabilitation of a patient who has undergone radical prostatectomy. This article describes the main modern techniques and methods for performing radical laparoscopic prostatectomy, which are aimed at achieving the earliest possible recovery of the urine retention mechanism.

Traditional laparoscopic radical prostatectomy is a treatment choice in many developing countries and regions for most patients with localized prostate cancer; however, no system for predicting surgical difficulty and risk has been established. This study aimed to propose a simple and standard preoperative classification system of prostate cancer using preoperative data to predict surgical difficulty and risk and to evaluate the relationship between the data and postoperative complications. We collected data from 236 patients and divided them into three groups to evaluate and validate the relationships among preoperative, operative, and postoperative data. This new scoring system is based on the body mass index, ultrasonic prostate volume, preoperative prostate-specific antigen level, middle lobe protrusion, and clinical stage. In the scoring group, we classified 89 patients into two groups: the low-risk group (score of

Abstract Background There have been few reports on health-related quality of life (HRQOL) after laparoscopic radical prostatectomy (LRP) in Japanese patients. The aim of this study is to assess changes in HRQOL during 36 months after LRP compared with retropubic radical prostatectomy (RRP). Methods The subjects were 105 consecutive patients treated with LRP between 2011 and 2012. HRQOL was evaluated using the International Prostate Symptom Score (IPSS), Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and Expanded Prostate Cancer Index Composite (EPIC) at baseline and 1, 3, 6, 12 and 36 months after surgery. These results were compared with data for 107 consecutive patients treated with RRP between 2005 and 2007. The comparison between LRP and RRP was examined at every time point by Mann-Whitney U-test and chi-square test. Multiple linear regression analysis was used to identify independent factors related to the urinary domain in EPIC. Results The IPSS change was similar in both groups. The LRP group had a better SF-8 mental component summary score at baseline and a better SF-8 physical component summary score at 1 month after surgery. In EPIC, urinary function and bother were worse after LRP, but improved at 12 months and did not differ significantly from those after RRP; however, these factors then worsened again at 36 months after LRP. Urinary incontinence was also worse at 36 months after LRP, compared to RRP. In patients treated with nerve-sparing surgery, urinary function and urinary incontinence were similar and good at 12 and 36 months in both groups. Bowel function and bother, and sexual function and bother were similar in both groups and showed no changes from 12 to 36 months. Age and salvage radiotherapy were independent predictors of incontinence (daily use of two or more pads) in multivariate analysis. Surgical procedure was not an independent factor for incontinence, but incontinence defined as use of one pad or more was associated with the surgical procedure. Conclusions Urinary function and bother at 36 months were worse after LRP than after RRP. Age, salvage radiotherapy and surgical procedure were associated with urinary incontinence after 36 months.

Minimally invasive techniques including robotic-assisted and laparoscopic radical prostatectomy have become the preferred approach for operative treatment of prostate cancer. The aim of this study was to evaluate and compare results of laparoscopic radical prostatectomy (LRP) and open retropubic radical prostatectomy (ORRP) for localised prostate cancer, in terms of safety, efficacy and oncological outcome. A total of 123 radical prostatectomies (RPs) for low-risk localised prostate cancer were performed between January 2016 and June 2019 at the University Clinic of Urology Skopje. Of these, 61 (49.6%) were LRP and 62 (50.4%) ORRP, mean patients' age was 54 years (33 to 67). Indications for operative procedure included: pathohistological finding of prostate cancer, age ≤ 70 years, PSA < 10 ng/ml, Gleason score ≤ 7 (3+3 or 3+4), negative bone scintigraphy, stage ≤ T2a, N0, M0. All patients were assessed regarding the demographic data, PSA level, Gleason score, operative time, conversion to open surgery for LRP, blood loss, intra and post operative complications, catheter removal, number blood transfusion, hospital stay and oncological outcomes. LRP proved superior to ORRP, resulting in a shorter operating time, less blood loss (p < 0.5), shorter time to resumption of oral intake, shorter postoperative hospital stay (p < 0.5), and less analgesic requirements. In terms of oncological outcomes, we observed less positive margins in the LRP group (p < 0.5). Our results indicate that although both operative techniques represent safe procedures, offering good quality of operation, in our series, LRP was superior in terms of safety, efficacy and oncological outcomes. [ABSTRACT FROM AUTHOR]

Objective: At present, prostate cancer radical surgery still lacks an objective standard for predicting the anatomic difficulty of surgery through preoperative examination. Due to the poor prognosis and surgical complications caused by "Narrow Pelvis," a pelvic model for prediction is urgently needed. The purpose of this study is to present objective preoperative assessing indicators to predict the surgical difficulty caused by pelvic anatomic abnormalities during laparoscopic radical prostatectomy (LRP). Methods: Patients undergoing LRP were retrospectively analyzed and separated into "Common Pelvis" or "Difficult Pelvis" groups according to the preset criteria. The clinical data and pelvic imaging data of the two groups were compared to obtain statistically significant differences. The results were compared and validated in 500 ordinary males. Logistic regression analysis was performed to optimize these indicators into a scoring model, "Laparoscopic Radical Prostatectomy Narrow Pelvic Predictive Index (LRP-NPPI)" for predicting "Difficult Pelvis." Results: Of the 145 patients undergoing LRP, 22 (15.2%) were included in the "Difficult Pelvis" group. Patients in the "Difficult Pelvis" group were more likely to have a narrower, shorter, deeper, more flattened pelvis, greater body mass index, more history of previous pelvic surgery, and greater prostate volume. Moreover, the larger amount of intraoperative blood loss and longer operation time were related. Compared with the "Common Pelvis" group, patients in the "Difficult Pelvis" have higher score of LRP-NPPI (p < 0.05). Conclusion: With the model we proposed, it is possible to predict patients with pelvic anatomical difficulties during LRP. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility of three bladder neck reconstruction (BNR) techniques in laparoscopic radical prostatectomy (laparoscopic RP) and their effects on urinary continence. Methods: We retrospectively analyzed 121 patients with organ-confined prostate cancer, who underwent laparoscopic RP in our center from March to December 2018. Three BNR techniques—zero o'clock reconstruction (ZOR), six o'clock reconstruction (SOR), and three/nine o'clock reconstruction (T/NOR)—applied in patients with large bladder opening after prostate resection are described comprehensively. Demographic and perioperative data were collected and analyzed using Pearson's chi-square and one-way analysis of variance test. Multivariate analysis was performed to explore predictors that affected continence recovery in 24 hours, 1 month, 3 months, and 6 months after catheter removal. Results: Laparoscopic RP was performed in all patients, wherein 37, 35, 34, and 15 patients underwent bladder neck preservation, ZOR, SOR, and T/NOR techniques, respectively. There were more high-risk patients and larger mean prostate volume in groups with BNR techniques. Perioperatively, patients with reconstruction techniques had longer operation and anastomosis time, more estimated blood loss, and more positive margin status. Nevertheless, there was no significant difference among four groups regarding continence recovery in 24 hours, 1 month, 3 months, and 6 months after catheter removal. On multivariable analysis, positive apical margin and long anastomosis time were independent adverse predictors of continence recovery in 24 hours. Large prostate volume and positive apical margin were adverse factors of continence recovery at 1, 3, and 6 months. Conclusion: Three different kinds of BNR techniques were safe and feasible in laparoscopic RP and had no different impact on continence recovery. Positive apical margin, large prostate volume, and long anastomosis time were independent adverse predictors of continence. [ABSTRACT FROM AUTHOR]