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POD-1.01: Trifecta Outcomes in Preoperatively Potent Men After Nerve Sparing Robotic Laparoscopic Radical Prostatectomy
PODIUM SESSIONS
Table, POD-1.02. Laparoscopic Partial Nephrectomy & Warm Ischemia Time
Podium Session POD-1: Minimally Invasive Surgery Thursday, November 20 1115-1305 POD-1.01 Trifecta Outcomes in Preoperatively Potent Men After Nerve Sparing Robotic Laparoscopic Radical Prostatectomy Orvieto M, Shikanov S, Zorn K, Shalhav A, Zagaja G University of Chicago, Chicago, USA Introduction and Objectives: We evaluated trifecta outcomes (continence, potency and undetectable PSA) for preoperatively continent and potent men following robotic laparoscopic radical prostatectomy (RLRP) with bilateral nerve sparing technique. Materials and Methods: The prospective RLRP database was analyzed for patients with ⱖ1 year follow up. Continence and potency were evaluated using both UCLAPCI questionnaire (no pads, erections sufficient for intercourse) and as reported at patient-surgeon encounter. Trifecta rates were calculated for both definitions. PSA⬎0.05 ng/ml was defined as biochemical recurrence. Results: Out of 1348 RLRP patients operated between February 2003 and January 2008, 380 were continent and potent preoperatively (per UCLA-PCI) and had at least 1 year follow up. The subjective (per patient-surgeon encounter) and objective (per UCLA-PCI) trifecta rates were 34% vs. 16%, 52% vs. 31%, 71% vs. 44% and 76% vs. 44% at 3,6,12 and 24 months, respectively. The differences between the values are statistically significant (p⬍0.0001). Conclusions: Trifecta rates following RLRP are similar to previously reported but vary significantly depending upon definitions applied for postoperative continence and potency. POD-1.02 The Impact of Warm Ischemia Time on Perioperative Outcomes and Creatinine Clearance in Patients Undergoing Laparoscopic Partial Nephrectomy Orvieto M, Bernstein A, Katz M, Eng M, Zorn K, Shalhav A University of Chicago, Chicago, USA Introduction and Objectives: Due to the inability to achieve cold ischemia,
Age (years) BMI (kg/m2) Preop Size (cm) Preop SCr (mg/dl) Preop CrCl (ml/min/BSA) Major Complications Minor Complications Conversion to Open EBL (cc) OR Time (min.) Positive Surgical Margins Postop SCr (mg/dl) Postop CrCl (ml/min/BSA)
Group A (N ⴝ 48) 59.7 29.5 2.2 1.11 87.75 6 (12.5%) 2 (4.2%) 3 (6.3%) 183 207.6 2 (4.2%) 1.29 71.3
laparoscopic partial nephrectomy (LPN) is generally performed under warm ischemic conditions. We sought to compare the perioperative outcomes of LPN with short (⬍30 min.) versus long (⬎30 min) warm ischemia time (WIT). In addition, we evaluated the postoperative serum creatinine (SCr) as well as creatinine clearance (CrCl) to determine the impact of WIT on postoperative renal function. Materials and Methods: Our prospective database of 129 laparascopic partial nephrectomies was reviewed. Forty-eight (Group A) and 63 (Group B) patients were noted to have WIT ⬍30 minutes and ⬎ 30 minutes, respectively. The impact of tumor size, patient age, body mass index (BMI, kg/m2), tumor location and depth on warm ischemia time (WIT) was assessed. Perioperative complications, estimated blood loss (EBL), operative time and pathological margin status were compared between the groups. In addition, SCr as well as CrCl (Cockroft-Gault) were assessed at postoperative intervals greater than one month (Table 1). Results: Patients in Group A had significantly smaller tumors and shorter operative time than those in Group B. Mean age, BMI, preoperative renal function, tumor location, depth, and complication rates were similar between the two groups. The mean postoperative SCr and CrCl did not differ between the groups (median follow-up ⫽ 6.3 months). Conclusions: Longer WIT is associated with larger renal tumors. However, complication rates, conversion rates, and EBL were not statistically different among groups. Pathological margin status was not affected by WIT. Most importantly, longer WIT did not impact long-term sCr and CrCl.
UROLOGY 72 (Supplement 5A), November 2008
Group B (N ⴝ 63) 59.9 30.1 3.1 1.13 80.89 7 (11.1%) 2 (3.2%) 1 (1.6%) 184 242.9 2 (3.2%) 1.37 81.6
P-Value 0.93 0.54 0.0004 0.91 0.46
0.9669 0.0092 0.71 0.26
POD-1.03 The Adjustable Male Sling for Stress Urinary Incontinence After Prostate Surgery Schrier B Jeroen Bosch Hospital, ’S-Hertogenbosch, Netherlands Introduction and Objective: Stress urinary incontinence (SUI) after prostate surgery has significant impact on patient’s quality of life. The Adjustable Male Sling (AMS) [Argus, Promedon] has gained popularity for the treatment of this condition as previous series showed encouraging results. The safety and efficacy of this procedure is evaluated and presented in a prospective study. Materials and Methods: From April 2005 to April 2008, for a total of 78 consecutive men [mean age 66 y. (range 52 to 80 y.)], placement of the AMS was performed for SUI after post prostate surgery [radical prostatectomy: (50 open retropubic; 20 laparoscopic; 4 open perineal), TUR-P: 4]. Pre- and post-operative evaluation consisted of history [including International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF-22; 0 to 100%) and global satisfaction analog scale (VAS 0 to 100%)] and pad per day count. Results: Mean pads per day before surgery was 4 (range 2 to 10). The mean preoperative ICIQ-SF was 75% (range 7 to 79%) and the VAS about continence was 20% (range 0 to 50%). Perforation of the bladder occurred in 12 (15%) of the cases during surgery and was corrected in all cases during the same procedure. Urinary retention was seen in 18 (23%) of patients postoperatively and resolved spontaneously in all cases. The AMS was removed in 7 (9%) cases (3 due to erosion, 4 caused by infection). Readjustment of the sling was requested in 15 (19%) cases.
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Table, POD-1.02. Laparoscopic Partial Nephrectomy & Warm Ischemia Time
Podium Session POD-1: Minimally Invasive Surgery Thursday, November 20 1115-1305 POD-1.01 Trifecta Outcomes in Preoperatively Potent Men After Nerve Sparing Robotic Laparoscopic Radical Prostatectomy Orvieto M, Shikanov S, Zorn K, Shalhav A, Zagaja G University of Chicago, Chicago, USA Introduction and Objectives: We evaluated trifecta outcomes (continence, potency and undetectable PSA) for preoperatively continent and potent men following robotic laparoscopic radical prostatectomy (RLRP) with bilateral nerve sparing technique. Materials and Methods: The prospective RLRP database was analyzed for patients with ⱖ1 year follow up. Continence and potency were evaluated using both UCLAPCI questionnaire (no pads, erections sufficient for intercourse) and as reported at patient-surgeon encounter. Trifecta rates were calculated for both definitions. PSA⬎0.05 ng/ml was defined as biochemical recurrence. Results: Out of 1348 RLRP patients operated between February 2003 and January 2008, 380 were continent and potent preoperatively (per UCLA-PCI) and had at least 1 year follow up. The subjective (per patient-surgeon encounter) and objective (per UCLA-PCI) trifecta rates were 34% vs. 16%, 52% vs. 31%, 71% vs. 44% and 76% vs. 44% at 3,6,12 and 24 months, respectively. The differences between the values are statistically significant (p⬍0.0001). Conclusions: Trifecta rates following RLRP are similar to previously reported but vary significantly depending upon definitions applied for postoperative continence and potency. POD-1.02 The Impact of Warm Ischemia Time on Perioperative Outcomes and Creatinine Clearance in Patients Undergoing Laparoscopic Partial Nephrectomy Orvieto M, Bernstein A, Katz M, Eng M, Zorn K, Shalhav A University of Chicago, Chicago, USA Introduction and Objectives: Due to the inability to achieve cold ischemia,
Age (years) BMI (kg/m2) Preop Size (cm) Preop SCr (mg/dl) Preop CrCl (ml/min/BSA) Major Complications Minor Complications Conversion to Open EBL (cc) OR Time (min.) Positive Surgical Margins Postop SCr (mg/dl) Postop CrCl (ml/min/BSA)
Group A (N ⴝ 48) 59.7 29.5 2.2 1.11 87.75 6 (12.5%) 2 (4.2%) 3 (6.3%) 183 207.6 2 (4.2%) 1.29 71.3
laparoscopic partial nephrectomy (LPN) is generally performed under warm ischemic conditions. We sought to compare the perioperative outcomes of LPN with short (⬍30 min.) versus long (⬎30 min) warm ischemia time (WIT). In addition, we evaluated the postoperative serum creatinine (SCr) as well as creatinine clearance (CrCl) to determine the impact of WIT on postoperative renal function. Materials and Methods: Our prospective database of 129 laparascopic partial nephrectomies was reviewed. Forty-eight (Group A) and 63 (Group B) patients were noted to have WIT ⬍30 minutes and ⬎ 30 minutes, respectively. The impact of tumor size, patient age, body mass index (BMI, kg/m2), tumor location and depth on warm ischemia time (WIT) was assessed. Perioperative complications, estimated blood loss (EBL), operative time and pathological margin status were compared between the groups. In addition, SCr as well as CrCl (Cockroft-Gault) were assessed at postoperative intervals greater than one month (Table 1). Results: Patients in Group A had significantly smaller tumors and shorter operative time than those in Group B. Mean age, BMI, preoperative renal function, tumor location, depth, and complication rates were similar between the two groups. The mean postoperative SCr and CrCl did not differ between the groups (median follow-up ⫽ 6.3 months). Conclusions: Longer WIT is associated with larger renal tumors. However, complication rates, conversion rates, and EBL were not statistically different among groups. Pathological margin status was not affected by WIT. Most importantly, longer WIT did not impact long-term sCr and CrCl.
UROLOGY 72 (Supplement 5A), November 2008
Group B (N ⴝ 63) 59.9 30.1 3.1 1.13 80.89 7 (11.1%) 2 (3.2%) 1 (1.6%) 184 242.9 2 (3.2%) 1.37 81.6
P-Value 0.93 0.54 0.0004 0.91 0.46
0.9669 0.0092 0.71 0.26
POD-1.03 The Adjustable Male Sling for Stress Urinary Incontinence After Prostate Surgery Schrier B Jeroen Bosch Hospital, ’S-Hertogenbosch, Netherlands Introduction and Objective: Stress urinary incontinence (SUI) after prostate surgery has significant impact on patient’s quality of life. The Adjustable Male Sling (AMS) [Argus, Promedon] has gained popularity for the treatment of this condition as previous series showed encouraging results. The safety and efficacy of this procedure is evaluated and presented in a prospective study. Materials and Methods: From April 2005 to April 2008, for a total of 78 consecutive men [mean age 66 y. (range 52 to 80 y.)], placement of the AMS was performed for SUI after post prostate surgery [radical prostatectomy: (50 open retropubic; 20 laparoscopic; 4 open perineal), TUR-P: 4]. Pre- and post-operative evaluation consisted of history [including International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF-22; 0 to 100%) and global satisfaction analog scale (VAS 0 to 100%)] and pad per day count. Results: Mean pads per day before surgery was 4 (range 2 to 10). The mean preoperative ICIQ-SF was 75% (range 7 to 79%) and the VAS about continence was 20% (range 0 to 50%). Perforation of the bladder occurred in 12 (15%) of the cases during surgery and was corrected in all cases during the same procedure. Urinary retention was seen in 18 (23%) of patients postoperatively and resolved spontaneously in all cases. The AMS was removed in 7 (9%) cases (3 due to erosion, 4 caused by infection). Readjustment of the sling was requested in 15 (19%) cases.
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