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MP51-08 FACTORS LEADING TO PROLONGED CATHETER TIME AFTER LAPAROSCOPIC AND ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY
THE JOURNAL OF UROLOGYâ
e600
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
MP51-09 DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING AND MR SPECTROSCOPY TO DETECT CANCER DISTRIBUTION IN PROSTATE. Kosuke Kitamura*, Satoru Muto, Shou-ichirou Sugiura, Akira Horiuchi, Masa-aki Koja, Akiko Nakajima, Masahiro Inoue, Yasuhiro Noma, Shino Tokiwa, Keisuke Saitou, Shuji Isotani, Hisamitsu Ide, Raizou Yamaguchi, Shigeo Horie, Tokyo, Japan
Source of Funding: none
MP51-08 FACTORS LEADING TO PROLONGED CATHETER TIME AFTER LAPAROSCOPIC AND ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Marcel Hruza*, Jan Klein, Ali Goezen, Michael Schulze, Jens Rassweiler, Heilbronn, Germany INTRODUCTION AND OBJECTIVES: On day 7 after laparoscopic radical prostatectomy (LRP) / robotic-assisted LRP (RALP), we usually do a cystogram and remove the foley catheter when watertightness of the anastomosis is shown. Prolonged catheter time is defined as necessity to leave the catheter due to leakage in this first cystogram. In these patients, a second cystogram is performed 10-14 days after surgery to re-access the anastomosis. The objective of this study is to investigate the occurrence of prolonged catheter time in a large single-institutional cohort and to identify parameters leading to prolonged catheter time. METHODS: Time to removal of the catheter was available in 2772 of the 2800 first consecutive patients who underwent LRP / RALP in our institution. Univariate and multivariate logistic regression models were used to investigate the relationship between operative parameters / patient characteristics and prolonged catheter time. RESULTS: Mean time to catheter removal was 12.1 days, standard deviation 9.3 days, median 7 days. The difference between the first 700 patients (mean time to catheter removal 13.9 days) and the last 700 (mean time 9.8 days) was statistically significant (p < 0.0001). Prolonged catheter time was observed in 926 of 2772 patients (33.4 %). Multivariate analysis showed interrupted suture for vesicourethral anastomosis, non-nerve sparing technique, non-bladder neck sparing technique, leakage of the anastomosis when the bladder is filled during surgery and an operating room time > 4 hours as significant predictors of prolonged catheter time (p < 0.05). Other factors (surgeon, use of the robot, use of the Rocco stitch, weight of the prostate, Gleason score, previous transurethral resection of the prostate) showed significance in univariate, but not in multivariate analysis. Age, body mass index and pathological tumor stage had no significant impact on catheter time. CONCLUSIONS: The operative technique is the key factor to achieve a short catheter time after LRP / RALP. A running suture for vesicourethral anastomosis, nerve sparing and bladder neck sparing technique, watertightness of the anastomosis during surgery and a short operating room time showed significant influence. Catheter time is neither depending on patient characteristics (age, weight, size of the prostate), nor on pathological characteristics. Source of Funding: none
INTRODUCTION AND OBJECTIVES: The management of localized prostate cancer (PCa) is in rapid evolution. In CaPSURE, the proportion of patients with low-risk disease has increased, and conversely, high-risk diagnoses have decreased. To prevent overtreatment, new concept of active surveillance and focal therapy as opposed to traditional radical treatment have appeared in clinical practice. The most important thing is, however, to diagnose the precise distribution and characteristics of all cancer lesions including daughter small tumors. The purpose of this study is to evaluate the efficacy of diffusion-weighted MRI (DWI), MR Spectroscopy (1HMRS) and prostate biopsy (PBx) for detecting the intraprostatic cancer distribution. METHODS: We included 54 consecutive patients with PCa in this retrospective study. All patients received DWI, 1H-MRS and PBx followed by radical prostatectomy. As a matter of convenience of comparing these imaging and histological outcome, a prostate was divided into 12 sections. Each of these regions was examined for the presence/absence of malignancy on the basis of DWI, 1H-MRS, and PBx, respectively. Then, these results were compared with the histopathological findings for the total prostatectomy specimens. We judge the sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of DWI, 1H-MRS, and PBx by computing the area under the Receiver Operator Characteristic curve (AUC). RESULTS: We included 53 patients (median age, 63 years; range, 43-75 years). Median PSA value was 5.8 ng/ml (range; 2.126.3). We could detect cancer lesion in 242 of 636 evaluable lesions. Every parameters of DWI for the diagnosis of prostate cancer was higher compared with 1H-MRS, and PBx (sensitivity: DWI 93.2%, 1HMRS 78.4%, PBx 87.9%; PPV: DWI 68.3%, 1H-MRS 68.1% PBx 67.7%; NPV: DWI 63.5%, 1H-MRS 45.1%, PBx 50.5%) (Figure). AUC analysis found that DWI also had an higher AUC of 0.57 compared with 1H-MRS (0.55) and PBx (0.55). CONCLUSIONS: DWI is more efficient than 1H-MRS and PBx in the detection of intraprostatic cancer distribution.
Source of Funding: none
e600
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
MP51-09 DIFFUSION-WEIGHTED MAGNETIC RESONANCE IMAGING AND MR SPECTROSCOPY TO DETECT CANCER DISTRIBUTION IN PROSTATE. Kosuke Kitamura*, Satoru Muto, Shou-ichirou Sugiura, Akira Horiuchi, Masa-aki Koja, Akiko Nakajima, Masahiro Inoue, Yasuhiro Noma, Shino Tokiwa, Keisuke Saitou, Shuji Isotani, Hisamitsu Ide, Raizou Yamaguchi, Shigeo Horie, Tokyo, Japan
Source of Funding: none
MP51-08 FACTORS LEADING TO PROLONGED CATHETER TIME AFTER LAPAROSCOPIC AND ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Marcel Hruza*, Jan Klein, Ali Goezen, Michael Schulze, Jens Rassweiler, Heilbronn, Germany INTRODUCTION AND OBJECTIVES: On day 7 after laparoscopic radical prostatectomy (LRP) / robotic-assisted LRP (RALP), we usually do a cystogram and remove the foley catheter when watertightness of the anastomosis is shown. Prolonged catheter time is defined as necessity to leave the catheter due to leakage in this first cystogram. In these patients, a second cystogram is performed 10-14 days after surgery to re-access the anastomosis. The objective of this study is to investigate the occurrence of prolonged catheter time in a large single-institutional cohort and to identify parameters leading to prolonged catheter time. METHODS: Time to removal of the catheter was available in 2772 of the 2800 first consecutive patients who underwent LRP / RALP in our institution. Univariate and multivariate logistic regression models were used to investigate the relationship between operative parameters / patient characteristics and prolonged catheter time. RESULTS: Mean time to catheter removal was 12.1 days, standard deviation 9.3 days, median 7 days. The difference between the first 700 patients (mean time to catheter removal 13.9 days) and the last 700 (mean time 9.8 days) was statistically significant (p < 0.0001). Prolonged catheter time was observed in 926 of 2772 patients (33.4 %). Multivariate analysis showed interrupted suture for vesicourethral anastomosis, non-nerve sparing technique, non-bladder neck sparing technique, leakage of the anastomosis when the bladder is filled during surgery and an operating room time > 4 hours as significant predictors of prolonged catheter time (p < 0.05). Other factors (surgeon, use of the robot, use of the Rocco stitch, weight of the prostate, Gleason score, previous transurethral resection of the prostate) showed significance in univariate, but not in multivariate analysis. Age, body mass index and pathological tumor stage had no significant impact on catheter time. CONCLUSIONS: The operative technique is the key factor to achieve a short catheter time after LRP / RALP. A running suture for vesicourethral anastomosis, nerve sparing and bladder neck sparing technique, watertightness of the anastomosis during surgery and a short operating room time showed significant influence. Catheter time is neither depending on patient characteristics (age, weight, size of the prostate), nor on pathological characteristics. Source of Funding: none
INTRODUCTION AND OBJECTIVES: The management of localized prostate cancer (PCa) is in rapid evolution. In CaPSURE, the proportion of patients with low-risk disease has increased, and conversely, high-risk diagnoses have decreased. To prevent overtreatment, new concept of active surveillance and focal therapy as opposed to traditional radical treatment have appeared in clinical practice. The most important thing is, however, to diagnose the precise distribution and characteristics of all cancer lesions including daughter small tumors. The purpose of this study is to evaluate the efficacy of diffusion-weighted MRI (DWI), MR Spectroscopy (1HMRS) and prostate biopsy (PBx) for detecting the intraprostatic cancer distribution. METHODS: We included 54 consecutive patients with PCa in this retrospective study. All patients received DWI, 1H-MRS and PBx followed by radical prostatectomy. As a matter of convenience of comparing these imaging and histological outcome, a prostate was divided into 12 sections. Each of these regions was examined for the presence/absence of malignancy on the basis of DWI, 1H-MRS, and PBx, respectively. Then, these results were compared with the histopathological findings for the total prostatectomy specimens. We judge the sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of DWI, 1H-MRS, and PBx by computing the area under the Receiver Operator Characteristic curve (AUC). RESULTS: We included 53 patients (median age, 63 years; range, 43-75 years). Median PSA value was 5.8 ng/ml (range; 2.126.3). We could detect cancer lesion in 242 of 636 evaluable lesions. Every parameters of DWI for the diagnosis of prostate cancer was higher compared with 1H-MRS, and PBx (sensitivity: DWI 93.2%, 1HMRS 78.4%, PBx 87.9%; PPV: DWI 68.3%, 1H-MRS 68.1% PBx 67.7%; NPV: DWI 63.5%, 1H-MRS 45.1%, PBx 50.5%) (Figure). AUC analysis found that DWI also had an higher AUC of 0.57 compared with 1H-MRS (0.55) and PBx (0.55). CONCLUSIONS: DWI is more efficient than 1H-MRS and PBx in the detection of intraprostatic cancer distribution.
Source of Funding: none