458“Was there any leakage?” — Questionnaire based recovery of urinary continence after laparoscopic radical prostatectomy

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EXTENDED PELVIC LYMPH NODE DISSECTION - THE GOLD STANDARD F O R L A P A R O S C O P I C T R E A T M E N T O F PATIENTS AT R I S K F O R L Y M P H N O D E METASTASES IN C L I N I C A L L Y L O C A L I Z E D PROSTATE CANCER?

THERE ANY LEAKAGE?" - QUESTIONNAIRE BASED RECOVERY OF URINARY CONTINENCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY

Seifert H.H., Bachmann A., Whyler S., Casella R., Ruszat R., M/_iller A., Sulser T. University Hospital, Department of Urology, Basel, Switzerland I N T R O D U C T I O N & O B J E C T I V E S : The superiority of extended pelvic lymph node dissection (ELND) in detecting lymph node metastasis in patients with clinically localized prostate cancer has been reported by several authors. We investigated the feasibility and efficiency of laparoscopic ELND in a prospective study. M A T E R I A L & M E T H O D S : Between May 2002 and October 2004 259 patients underwent laparoscopic radical prostatectomy for clinically localized prostate cancer. In 96 patients ELND was performed laparoscopically if PSA was >10 ug/1, Gleason Score > 6, evidence for lymph node metastasis in CT scan or more than 50% of the biopsies were positive. Lymph node detection rate and complication rate were prospectively documented. RESULTS: Mean operation time was 554- 18 min. There were no intraoperative surgical complications. Positive lymph nodes were detected in 14 patients (14.6%). In these cases significantly more lymph nodes were removed (26.3 lymph nodes range 8-55) compared to the lymph node negative patients (19.4 lymph nodes range 6-42). Preoperative PSA level was slightly higher in the lymph node positive group (18.98 ug/1 range 1.9-43.4) compared to patients without lymph node metastasis (15.59 ug/1 range 2.9-97). Drainage was inserted in 71 cases for 2.8 d (range 1-13). A prolonged drainage was necessary in 3 patients because of persisting lymphatic secretion. The last 25 patients did not get drainage without any postoperative complications. C O N C L U S I O N S : Extended laparoscopic pelvic lymph node dissection is feasible and efficient with regard to the number of the removed lymph nodes and detected lymph node metastases. Mean operative time justifiable and the morbidity of the procedure are low. Therefore we recommend that transperitoneal extended pelvic lymph node dissection should be the Gold standard in laparoscopic treatment of patients at risk for lymph node metastasis with clinically localized prostate cancer.

" W A S

Sulser %, Ruszat R., Wyler S., Seifert H.H., Bachmann A. University of Basel, Department of Urology, Basel, Switzerland INTRODUCTION & OBJECTIVES: We evaluate the fully restoration of urinary continence after laparoscopic radical prostateetomy with a self-administered patients questionnaire. MATERIAL & METHODS: All consecutive patients with localized prostate cancer (n:265), who underwent laparoscopic radical prostatectomy, were prospectively asked to fulfil a urinary questionnaire, previously to operation and within the follow-up. Data of 236 patients are suitable for analysis. Follow-up was performed in our hospital at 6 weeks (n=236), 3 months (n=236), 6 months (n=176), 1 year (n-158) and up to 2 years (n=36) postoperatively. Follow-up was performed at our hospital. Special interest was paid on the issue: "urinary leakage". RESULTS: Mean age was 63.5±6.2 years; an average of 8.5 stitches for the vesicourethral anastomosis was performed. Postoperative transurethral catheterization time was 5.1±4.7 days. Previous to surgery 173 (73%) patients reported complete urinary continence. 15% (n-35) reported slight, 10% (n-24%) moderate and 2% severe urinary incontinence preoperatively. After laparoscopic radical prostatectomy self-administered questionnaire based urinary continence rates (no pad, no leak) were as follows (discharge, 6wk, 3, 6, 12 and 24mo.): 63%, 47%, 65%, 71%, 72% and 78%, respectively. Urinary incontinence impaired dramatically early after surgery (6wk) and "severe" incontinence reached a maximum of 7% within the follow-up period. This dramatic impairment restored mainly after 3mo. Moderate urinary incontinence was present in 22% up to 6ran. postoperatively. After 6ran. 71% of all patients recovered, to full urinary continence that is comparable to baseline levels. Patients with moderate incontinence improved significantly between 6 to 12mo. (22% vs. 5%). Patients experienced only a slight improvement within the observation period of 6 to 24mo., respectively. CONCLUSIONS: Based on our data we conclude that urinary continence reports at time of discharge are not useful to estimate the continence situation within the early postoperative period. Early after surgery, most of the patients experience a dramatic impairment of urinary continence that is resolved 3 to 6ran. postoperatively. Urinary continence after laparoscopic radical prostatectomy returned to baseline level 6ran. after surgery. Patients have to be informed about this situation regarding the early postoperative period.

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T H E I M P A C T O F PROSTATE V O L U M E IN L A P A R O S C O P I C R A D I C A L PROSTATECTOMY

N - C A D H E R I N E X P R E S S I O N IS A S S O C I A T E D W I T H C A N C E R P R O G R E S S I O N AND P O O R P R O G N O S I S

Chang C., Gianduzzo T., Tan N., E1-Shazly M., Moon D., Eden C.

Tomita K., Kume H., Kashibuchi K., Kitamura T.

North Hampshire Hospital, Department of Urology, Basingstoke, United Kingdom

University of Tokyo, Urology, Tokyo, Japan

INTRODUCTION & OBJECTIVES: A large prostate may be a challenge during open or laparoscopic radical prostatectomy. A larger prostate gland (45g to 50g) increases operative time in transperitoneal laparoscopic radical prostatectomy (El-Feel 2003, Rassweiler 2001). Prostate gland size (greater than 75cc) in open surgery does not influence operative outcomes (Kirby 2003). The aim of this study was to analyse outcomes for laparoscopic radical prostateetomy (LRP) in prostate volumes less than and greater than 75cc.

INTRODUCTION & OBJECTIVES: For patients with bladder cancer, it has been well documented that decreased expression of E-cadherin is associated with a poor prognosis. The clinical data show that in several epithelial derived malignancies, the loss of E-cadherin expression is not only associated with invasiveness but also with metastatic behaviour and poor clinical outcome, suggesting that this event is pivotal in the complex metastatic cascade. In human bladder cancer cell lines, which lack expression of either E-cadherin or the catenins, and therefore lack an E-cadherin mediated cell-cell adhesion, show expression of N-cadherin. Considering that the d e novo expression of N-cadherin may hallmark changes in cell adhesion processes that are important for the thvasive and metastatic capacity of tile bladder cancer cells, we decided to investigate the expression of N-cadherin in human bladder cancer specimens by immunohistochemistry. We aim at establishing the pathological role of induced expression of N-cadherin in bladder cancer progression and show a correlation between expression of cadherins and clinical outcome.

MATERIAL & METHODS: 345 Cases of LRP were performed from March 2000 to September 2004. 111 LRP were performed using a transperitnneal approach and 234 using an extraperitoneal approach. 73 Patients had a prostate volume greater than or equal to 75cc and 272 had a prostate volume less than 75cc. Perioperative and postoperative parameters were measured and analysed for all patients to investigate differences in outcomes. RESULTS: Patients PSA, Gleason score, clinical stage, operative times, hospital stay were all similar. The complication rate was slightly greater in the larger prostate, however the positive margin rate was less. Medican Preopevolume rative (cc) PSA Prostat( 47 volmne less than 75ec Prostate 85 volume more than 75cc

7

17

Gleason Operascore tive time (rains) 6 180

Blood loss (mls)

Hospital Compli- Positive. stay cations margin (days) (%) rate (%)

200

3

4.4

21.3

6

300

3

8.2

6.9

200

CONCLUSIONS: For prostate volumes more than 75cc, the general outcome measures were unaffected. The complication rate was slightly higher; however, the positive margin rate was lower.

BLADDER

MATERIAL & METHODS: In 45 bladder cancer specimens of radical cystectomy or transurethral resection from1998 to 2001, double-label immunofluorescece staining of both E- and N-cadherin was performed, and patterns of these expressions were evaluated. Western blotting was done to detect the protein level of N-cadherin. We investigated to clarify the localization of N-cadherin expression using Confocal scanning laser microscopy (CSLM). RESULTS: In 45 bladder cancer specimens, turnout grade 1: 2:3 ratio was 4: 20: 21, and turnout stage pTa-l: pT2-4 ratio was 24:21. Normal expression of E-cadherin was found in 19 cases (42.2%), and positive expression of N-eadherin (membranous pattern and/or dotted pattern) was found in 24 cases (53.3%). There is a significant correlation between aberrant expression of E-cadberin and positive expression of N-cadherin (p<0.0001). Aberrant expression of E-cadherin and positive expression of N-cadherin have a significant correlation with mmour stage (io<0.05). In survival analysis, all 4 cases with strong expression of N-cadherin died of bladder cancer within 2 years. The ratio of 3 years survival rate was as follows: E-eadherin (normal I00%: aberrant 61.5%), and N-cadherin (positive 63.6%: negative 92.9%), respectively. There was a significant difference in survival between normal and aberrant expression of E-cadherin, or between positive and negative expression of N-cadherin. Bladder cancer cells invading stroma strongly showed positive N-cadherin expression by CSLM. In Western blotting for N-cadherin, most of cases with strong expression of N-cadherin revealed a positive band. CONCLUSIONS: Our data raise the possibility that positive expression of N-cadherin may play an important role in progression and survival of bladder cancer.

European Urology Supplements 4 (2005) No. 3, pp. 117