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787 SEMINAL VESICLE PRESERVATION DOES NOT IMPROVE FUNCTIONAL OUTCOME OF PATIENTS TREATED WITH BILATERAL NERVE SPARING RADICAL RETROPUBIC PROSTATECTOMY
Results: Endpoint was biochemical recurrence-free survival. Median f-up was 67 mos (4-102). Gleason score was 6 in 40% and 7 in 54% of pts. PSM occurred in 67 pts. (24.8%). After further resection, no residual cancer was found in 33 pts, with overall PSM rate reduction from 24.8% to 12.6%. At 67 mos, PSA recurrence was 2.45%, 15.1% and 11.7% in pts. with NSM, with no residual cancer after further resection of PSM at FS, and with residual cancer after further resection of PSM at FS, respectively. The difference after further resection between no residual cancer and residual cancer was not significant. In 113 pts undergoing NS technique, PSM occurred in 28 pts. (24.7%). After further resection, no residual cancer was found in 13 pts, with overall PSM rate reduction from 24.8% to 12.6%. At 71 mos, PSA recurrence was 10.5%, 30.7% and 26.7% in pts. with NSM, with no residual cancer after further resection of PSM at FS, and with residual cancer after further resection of PSM at FS, respectively. The difference was not significant. In 175 pts with pT2 prostate cancer, PSM occurred in 24 pts. (13.7%). After further resection, no residual cancer was found in 13 pts, with overall PSM rate reduction from 13.7% to 4.6%. At 71 mos, PSA recurrence was 2.45%, 0% and 0% in pts. with NSM, with no residual cancer after further resection of PSM at FS, and with residual cancer after further resection of PSM at FS, respectively. These data are conflicting and might deserve further investigation. Conclusions: No oncological benefit can be expected in most in pts. with initially PSM and no cancer tissue and further resection at positive site. FS doesn’t decrease PSM rate in radical prostatectomy.
786
The effect of dorsal vascular complex size on the recovery of continence after radical prostatectomy
Jeong C.W., Oh J.J., Na W., Nam J.S., Yoon C.Y., Jeong S.J., Hong S.K., Byun S., Lee S.E. Seoul National University Bundang Hospital, Dept. of Urology, Seongnam, South Korea Introduction & Objectives: Dorsal vascular complex (DVC) of the prostate is not a structure simply consisted of vessels and connective tissue but a functional structure having smooth muscles connected to the detrusor apron. Thus we evaluated whether the size of DVC measured by MRI had a relation to continence recovery after radical prostatectomy. Materials & Methods: We prospectively collected the clinical data including the results of prostate MRI and continence recovery of the patients who underwent radical prostatectomy in our institution. From April 2006 to February 2010, 862 patients received radical prostatectomy. Among these patients, the information of DVC could be checked in 832 cases. 101 cases were excluded because of missing data, a total of 731 cases were included in the final analysis. The continence was defined as no or a single secure pad requirement per day. The height and width of DVC were checked in the T1-weighted axial image in the level which showed puboprostatic ligament. And the area was calculated using the elliptic equations (height X width X π/4). Univariate and multivariate Cox proportional hazard regression models were used to analyze recovery of continence. Results: The mean age was 66.7±6.6 years, and the mean preoperative PSA was 12.8±18.3ng/ml. The continence rate of the total patients was 96.7%. The mean width and height of DVC were 2.0±0.4cm and 1.2±0.3cm, respectively. And the mean area of DVC was 1.8±0.6cm2. We could not find any relation between continence recovery with width, height, and area of DVC as in both continuous and categorical variables. Even in subgroup analyses by several criteria, the results were same. In univariate analysis, age, method of operation, transfusion, nerve-saving, the length of membranous urethra, extracapsular extension were significant variables to the recovery of the continence. Even in multivariate analysis, the dimensions of DVC were not significant factors, whereas age (HR 0.985, p=0.013, 95% CI: 0.973-0.997), transfusion (HR 0.701, p=0.010, 95% CI: 0.535-0.918), nerve-saving (HR 1.186, p=0.038, 95% CI: 1.009-1.394), the length of membranous urethra (HR 1.462, p=0.012, 95% CI: 1.088-1.964) were independent variables for recovery of continence. Conclusions: We could not find any relation between size of DVC and recovery of continence after radical prostatectomy. In most cases, DVC was ligated and transected. If DVC was huge, blooding was aggravated and the operation could be consequently difficult. The result could be caused by the nature of these complexities of radical prostatectomy and its recovery.
787
Seminal vesicle preservation does not improve functional outcome of patients treated with bilateral nerve sparing radical retropubic prostatectomy
Gallina A., Suardi N., Capitanio U., Tutolo M., Fossati N., Moschini M., Villa L., Gandaglia G., Di Girolamo V., Colombo R. Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Urology, Milan, Italy Introduction & Objectives: Controversy exists on the role of seminal vesicle (SV) preservation on functional outcomes of patients treated with nerve sparing radical prostatectomy (NSRP).. We tested the association of SV preservation on functional outcomes in a large series of patients treated by a single high volume surgeon at
a tertiary referral center. Materials & Methods: The study included 348 patients treated by a single high volume surgeon with retropubic bilateral NSRP (BNSRP) between 2002 and 2009 at a single tertiary referral center. Complete data, including age and PSA at surgery, clinical stage, biopsy Gleason sum and pre-operative IIEF-EF were available for all patients. Patient were divided into two groups according to the type of surgical approach: preservation (Group 1; n=247) vs. no preservation of the tip of SV (Group 2 ; n=101) during BNSRP. All patients were assessed postoperatively every 3 months and were asked to complete the IIEF during each visit. Post-operative EF recovery was defined as an EF domain score of the IIEF (IIEF-EF) ≥22, while UC recovery was defined as the absence of any protection device (no pads) after surgery. Kaplan-Meier curves assessed the time to EF and UC recovery in the overall patient population as well as in each group. The association between SV preservation and functional outcomes was also assessed in univariable and multivariable Cox regression models after adjusting for age at surgery, PSA at surgery, biopsy Gleason score, clinical stage and pre-operative EF. Results: Mean age at surgery was 63.2 yrs (median 63.1; range 42-72 yrs). Pre-operative IIEF-EF domain score assessment showed severe, moderate, mild to moderate, mild and no ED in 21.6, 5.6,5.6,19.5 and 46.7% of patients, respectively. Overall, 177/348 (50.9%) reached a IIEF-EF domain score ≥22 while 305/348 (87.6%) recovered UC after a mean follow-up of 21 months (median 19; range: 2-61). At Kaplan-Meier analyses, no difference in terms of EF as well as UC recovery between the two groups of patients (1 and 2-year EF recovery rates in group 1 vs. group 2: 42 and 54 vs. 33 and 54%, respectively; p=0.5; 1 and 2-year UC recovery rates in group 1 vs. group 2: 78 and 85 vs. 72 and 88%, respectively; p=0.6). These results were confirmed at multivariable analysis where the preservation of the tip of the SV did not achieve an independent predictor status for either EF or UC recovery after adjusting for all the mentioned predictors (all p≥0.4). Conclusions: We demonstrated that SV preservation is not associated with better functional outcomes of selected patients treated by a single high volume surgeon with BNSRP. These retrospective results need to be confirmed in large prospective, randomized trials.
788
Nerve-sparing technique during radical prostatectomy is strongly associated with the rate of urinary continence recovery. Long term follow up of a single tertiary care center
Suardi N.R., Gallina A., Capitanio U., Passoni N.M., Scattoni V., Da Pozzo L.F., Finocchio N., Briganti A. University Vita-Salute San Raffaele, Urological Research Institute, Dept. of Urology, Milan, Italy Introduction & Objectives: Controversy exists with regards to the role of neurovascular bundles preservation in the recovery of urinary continence (UC) after radical prostatectomy (RP). We hypothesized that NSRP may be associated to a higher rate of UC recovery after NSRP, as compared to non-NS procedures. Materials & Methods: The study included 1480 consecutive patients treated with RP between 2001 and 2010 at a single tertiary referral center. Complete pre- and intra-operative data, including age at surgery PSA, clinical stage, biopsy Gleason sum, and nerve sparing status namely, non NS, unilateral NS (UNS) and bilateral NS (BNS), were available for all patients. Patients were divided into 3 pre-operative risk groups: low (PSA<10 ng/ml, cT1, biopsy Gleason sum ≤6), high (cT3 or biopsy Gleason 8-10 or PSA >20 ng/ml) and intermediate risk (all the remaining patients). All patients were assessed post-operatively every 3 months for the first year, every 6 months for the second year and yearly thereafter. Post-operative UC recovery was defined as the absence of any protection device (no pads). Patients were subdivided into 3 groups according to NS status. Kaplan-Meier curves assessed the time to UC recovery in the overall patient population as well as in each group. The association between the NS status and UC recovery was assessed in univariable and multivariable Cox regression analyses after accounting for age at surgery and pre-operative risk groups. Results: Mean age at surgery was 64.0 yrs (median 64.3; range 39-85 yrs). Pre-operative risk groups included 642 (43.4%), 630 (42.6%) and 208 (14.1%) patients in the low, intermediate and high risk group, respectively. The 1 and 2-years UC recovery rates were significantly higher for patients treated with BNS as compared to UNS and non-NS patients (74% vs. 54% vs. 27% and 82% vs. 67% vs. 29%, respectively; p<0.001). These data were confirmed at multivariable Cox regression analyses where NS status was independently associated with UC recovery (p<0.001) even after accounting for patient age at surgery and preoperative oncologic characteristics. Patients treated with BNS had a 3.7 fold higher chance of full UC recovery as compared with patients receiving a non NSRP procedure (p<0.001). Similarly, UNS was associated to a 2.7 folds increase of full UC recovering, when compared with non NS patients. Conclusions: We demonstrated that patients treated with BNS have higher chances of recovering full continence (no pads) after RP. Therefore, when is technically feasible, a NS procedure should always attempted, in order to increase the probability of achieving fully continence after surgery.
Eur Urol Suppl 2011;10(2):249
786
The effect of dorsal vascular complex size on the recovery of continence after radical prostatectomy
Jeong C.W., Oh J.J., Na W., Nam J.S., Yoon C.Y., Jeong S.J., Hong S.K., Byun S., Lee S.E. Seoul National University Bundang Hospital, Dept. of Urology, Seongnam, South Korea Introduction & Objectives: Dorsal vascular complex (DVC) of the prostate is not a structure simply consisted of vessels and connective tissue but a functional structure having smooth muscles connected to the detrusor apron. Thus we evaluated whether the size of DVC measured by MRI had a relation to continence recovery after radical prostatectomy. Materials & Methods: We prospectively collected the clinical data including the results of prostate MRI and continence recovery of the patients who underwent radical prostatectomy in our institution. From April 2006 to February 2010, 862 patients received radical prostatectomy. Among these patients, the information of DVC could be checked in 832 cases. 101 cases were excluded because of missing data, a total of 731 cases were included in the final analysis. The continence was defined as no or a single secure pad requirement per day. The height and width of DVC were checked in the T1-weighted axial image in the level which showed puboprostatic ligament. And the area was calculated using the elliptic equations (height X width X π/4). Univariate and multivariate Cox proportional hazard regression models were used to analyze recovery of continence. Results: The mean age was 66.7±6.6 years, and the mean preoperative PSA was 12.8±18.3ng/ml. The continence rate of the total patients was 96.7%. The mean width and height of DVC were 2.0±0.4cm and 1.2±0.3cm, respectively. And the mean area of DVC was 1.8±0.6cm2. We could not find any relation between continence recovery with width, height, and area of DVC as in both continuous and categorical variables. Even in subgroup analyses by several criteria, the results were same. In univariate analysis, age, method of operation, transfusion, nerve-saving, the length of membranous urethra, extracapsular extension were significant variables to the recovery of the continence. Even in multivariate analysis, the dimensions of DVC were not significant factors, whereas age (HR 0.985, p=0.013, 95% CI: 0.973-0.997), transfusion (HR 0.701, p=0.010, 95% CI: 0.535-0.918), nerve-saving (HR 1.186, p=0.038, 95% CI: 1.009-1.394), the length of membranous urethra (HR 1.462, p=0.012, 95% CI: 1.088-1.964) were independent variables for recovery of continence. Conclusions: We could not find any relation between size of DVC and recovery of continence after radical prostatectomy. In most cases, DVC was ligated and transected. If DVC was huge, blooding was aggravated and the operation could be consequently difficult. The result could be caused by the nature of these complexities of radical prostatectomy and its recovery.
787
Seminal vesicle preservation does not improve functional outcome of patients treated with bilateral nerve sparing radical retropubic prostatectomy
Gallina A., Suardi N., Capitanio U., Tutolo M., Fossati N., Moschini M., Villa L., Gandaglia G., Di Girolamo V., Colombo R. Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Urology, Milan, Italy Introduction & Objectives: Controversy exists on the role of seminal vesicle (SV) preservation on functional outcomes of patients treated with nerve sparing radical prostatectomy (NSRP).. We tested the association of SV preservation on functional outcomes in a large series of patients treated by a single high volume surgeon at
a tertiary referral center. Materials & Methods: The study included 348 patients treated by a single high volume surgeon with retropubic bilateral NSRP (BNSRP) between 2002 and 2009 at a single tertiary referral center. Complete data, including age and PSA at surgery, clinical stage, biopsy Gleason sum and pre-operative IIEF-EF were available for all patients. Patient were divided into two groups according to the type of surgical approach: preservation (Group 1; n=247) vs. no preservation of the tip of SV (Group 2 ; n=101) during BNSRP. All patients were assessed postoperatively every 3 months and were asked to complete the IIEF during each visit. Post-operative EF recovery was defined as an EF domain score of the IIEF (IIEF-EF) ≥22, while UC recovery was defined as the absence of any protection device (no pads) after surgery. Kaplan-Meier curves assessed the time to EF and UC recovery in the overall patient population as well as in each group. The association between SV preservation and functional outcomes was also assessed in univariable and multivariable Cox regression models after adjusting for age at surgery, PSA at surgery, biopsy Gleason score, clinical stage and pre-operative EF. Results: Mean age at surgery was 63.2 yrs (median 63.1; range 42-72 yrs). Pre-operative IIEF-EF domain score assessment showed severe, moderate, mild to moderate, mild and no ED in 21.6, 5.6,5.6,19.5 and 46.7% of patients, respectively. Overall, 177/348 (50.9%) reached a IIEF-EF domain score ≥22 while 305/348 (87.6%) recovered UC after a mean follow-up of 21 months (median 19; range: 2-61). At Kaplan-Meier analyses, no difference in terms of EF as well as UC recovery between the two groups of patients (1 and 2-year EF recovery rates in group 1 vs. group 2: 42 and 54 vs. 33 and 54%, respectively; p=0.5; 1 and 2-year UC recovery rates in group 1 vs. group 2: 78 and 85 vs. 72 and 88%, respectively; p=0.6). These results were confirmed at multivariable analysis where the preservation of the tip of the SV did not achieve an independent predictor status for either EF or UC recovery after adjusting for all the mentioned predictors (all p≥0.4). Conclusions: We demonstrated that SV preservation is not associated with better functional outcomes of selected patients treated by a single high volume surgeon with BNSRP. These retrospective results need to be confirmed in large prospective, randomized trials.
788
Nerve-sparing technique during radical prostatectomy is strongly associated with the rate of urinary continence recovery. Long term follow up of a single tertiary care center
Suardi N.R., Gallina A., Capitanio U., Passoni N.M., Scattoni V., Da Pozzo L.F., Finocchio N., Briganti A. University Vita-Salute San Raffaele, Urological Research Institute, Dept. of Urology, Milan, Italy Introduction & Objectives: Controversy exists with regards to the role of neurovascular bundles preservation in the recovery of urinary continence (UC) after radical prostatectomy (RP). We hypothesized that NSRP may be associated to a higher rate of UC recovery after NSRP, as compared to non-NS procedures. Materials & Methods: The study included 1480 consecutive patients treated with RP between 2001 and 2010 at a single tertiary referral center. Complete pre- and intra-operative data, including age at surgery PSA, clinical stage, biopsy Gleason sum, and nerve sparing status namely, non NS, unilateral NS (UNS) and bilateral NS (BNS), were available for all patients. Patients were divided into 3 pre-operative risk groups: low (PSA<10 ng/ml, cT1, biopsy Gleason sum ≤6), high (cT3 or biopsy Gleason 8-10 or PSA >20 ng/ml) and intermediate risk (all the remaining patients). All patients were assessed post-operatively every 3 months for the first year, every 6 months for the second year and yearly thereafter. Post-operative UC recovery was defined as the absence of any protection device (no pads). Patients were subdivided into 3 groups according to NS status. Kaplan-Meier curves assessed the time to UC recovery in the overall patient population as well as in each group. The association between the NS status and UC recovery was assessed in univariable and multivariable Cox regression analyses after accounting for age at surgery and pre-operative risk groups. Results: Mean age at surgery was 64.0 yrs (median 64.3; range 39-85 yrs). Pre-operative risk groups included 642 (43.4%), 630 (42.6%) and 208 (14.1%) patients in the low, intermediate and high risk group, respectively. The 1 and 2-years UC recovery rates were significantly higher for patients treated with BNS as compared to UNS and non-NS patients (74% vs. 54% vs. 27% and 82% vs. 67% vs. 29%, respectively; p<0.001). These data were confirmed at multivariable Cox regression analyses where NS status was independently associated with UC recovery (p<0.001) even after accounting for patient age at surgery and preoperative oncologic characteristics. Patients treated with BNS had a 3.7 fold higher chance of full UC recovery as compared with patients receiving a non NSRP procedure (p<0.001). Similarly, UNS was associated to a 2.7 folds increase of full UC recovering, when compared with non NS patients. Conclusions: We demonstrated that patients treated with BNS have higher chances of recovering full continence (no pads) after RP. Therefore, when is technically feasible, a NS procedure should always attempted, in order to increase the probability of achieving fully continence after surgery.
Eur Urol Suppl 2011;10(2):249