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ROBOTIC SIMPLE PROSTATECTOMY
122
THE JOURNAL OF UROLOGY®
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
340 GEMCITABINE AND MITOMYCIN INTRAVESICAL THERAPY IN PATIENTS WITH RECURRENT BLADDER CANCER REFRACTORY TO BCG Benjamin N Breyer*, Jared M Whitson, Peter R Carroll, Badrinath R Konety. San Francisco, CA. INTRODUCTION AND OBJECTIVE: Currently, there are few options other than cystectomy for the management of BCG refractory non-muscle invasive bladder cancer. We report our experience with intravesical combination chemotherapy using gemcitabine and mitomycin in such patients. METHODS: The IRB approved UCSF Urologic Oncology Database (UODB) was queried to identify patients with BCG refractory, non-muscle invasive bladder cancer and were treated with gemcitabine and mitomycin. Data was collected regarding patient demographics, and disease information such as previous intravesical therapy, previous F\VWRVFRS\F\WRORJ\UHVXOWVWLPHWRUHFXUUHQFHDQGVLGHHIIHFWSUR¿OH 5HVSRQVHZDVGH¿QHGDVQRUPDOF\WRORJ\F\VWRVFRS\DQGRUELRSV\ Follow-up evaluations were performed at 3 monthly intervals following start of induction therapy. RESULTS: Seven patients who had failed intravesical BCG WKHUDS\ DW OHDVW [ DQG %&* ,QWHUIHURQ ĮE ZHUH WUHDWHG ZLWK D combination of intravesical gemcitabine (1000mg in 50 ml sterile water) followed sequentially by mitomycin (40mg in 20ml sterile water) intravesically every week for 6 weeks (induction). One patient had previous history of G1 Ta without CIS, 3 patients had HG Ta with CIS and 3 patients had HGT1 with CIS. Induction therapy was followed by a maintenance regimen using the same dose of Gemcitabine and Mitomycin once a month for 12 months. 2/7 (29%) patients did not UHVSRQGWRWKHWKHUDS\DQGKDGELRSV\SURYHQWXPRUDWWKH¿UVWIROORZXS cystoscopy 6 weeks after completion of induction. 5/7 (71%) patients demonstrated complete response and have maintained their response at a mean follow-up of 10.3 months (6.3±SD). The therapy was well tolerated. There were no major complications. 2/7 (29%) patients experienced irritative lower urinary tract symptoms which did not require cessation of therapy and 1/7 (14%) experienced a maculopapillary rash that improved with Benadryl. CONCLUSIONS: In patients, with recurrent BCG refractory bladder cancer, intravesical combination chemotherapy with gemcitabine and mitomycin appears to be well tolerated and yields a response in a VLJQL¿FDQWQXPEHURISDWLHQWV/RQJHUIROORZXSLVQHHGHGWRGHWHUPLQH RYHUDOOHI¿FDF\LQSUHYHQWLQJUHFXUUHQFHDQGSURJUHVVLRQ Source of Funding: None
Male Voiding Dysfunction, BPH and Didactic Urological Videos Video Session 1 Sunday, May 18, 2008
10:30 am - 12:30 pm
V341 MODIFIED RETROPUBIC OPEN PROSTATECTOMY USING A VESSEL SEALING SYSTEM Teruhisa Nomura*, Makoto Kawaguchi, Takashi Yamagishi, Hiroshi Nakagomi, Masami Aikawa, Isao Araki, Masayuki Takeda. Yamanashi, Japan. INTRODUCTION AND OBJECTIVE: The surgical treatment options for bladder outlet obstruction caused by benign prostatic hyperplasia have been expanded dramatically with the development of minimally invasive therapies. Retropubic open prostatectomy is, however, still needed to be performed in the patients with severe outlet obstruction caused by marked benign prostatic enlargement with more HI¿FDF\IRUDOOHYLDWLQJWKHV\PSWRPV:HGHYHORSHGDVDIHUDQGHDVLHU technique for capsulotomy in retropubic open prostatectomy using a vessel sealing system. METHODS: A special instrument needed is only Ligasure™ Xtd (Vallylab, Boulder, CO, USA). A 9 cm lower midline incision is SODFHG DQG WKH VSDFH RI 5HW]LXV LV H[SRVHG )RU FDSVXORWRP\ WZR hemostatic absorbable stitches are placed medially on each side of the transverse capsulotomy line estimated. The capsule between the
stitches is minimally incised with an electrocautery to expose adenoma. The blunt and gently curved tip of the Ligasure™ Xtd is inserted beneath the capsule, then the capsule is sealed more than three times at the VDPHSRUWLRQIRUFRPSOHWHKHPRVWDVLVDQGLVGLYLGHGZLWK0HW]HQEDXP scissors. The capsulotomy is completed by extending the incision VXI¿FLHQWO\ODWHUDOO\ZLWKUHSHDWLQJWKHVDPHSURFHGXUH$IWHUUHPRYLQJ DGHQRPDE\EOXQW¿QJHUGLVVHFWLRQKHPRVWDVLVLVFRPSOHWHGDQGWKH bladder neck mucosa is advanced into the prostatic fossa. Finally, the sealed capsule edge is closed by deep and wide stitches using 2-0 Vicryl sutures to avoid post-operative urine leakage. RESULTS: We performed the technique in 6 cases that had urinary retention or more than 100 ml of post-void residual urine. The mean operative time was 146 minutes. The mean blood loss including urine was 542 ml. The mean specimen weight removed was 88.3 g. The capsulotomy was completed within 13 minutes 22 seconds on the average without bleeding from the edge of the capsulotomy. In all cases, no perioperarive complication was seen, although urethral catheters ZHUHUHPRYHGRQWKHWKSRVWRSHUDWLYHGD\DIWHUFRQ¿UPLQJQROHDNDJH by retrograde cystography. The voiding status was excellent excepting urge incontinence in one case post-operatively. CONCLUSIONS: Using the vessel sealing system enables VDIHU DQG HDVLHU VLPSOL¿FDWLRQ RI FDSVXORWRP\ LQ UHWURSXELF RSHQ prostatectomy with minimum hemostatic absorbable stitches on the capsule, that may contribute to reducing the operative time and blood loss. Source of Funding: None
V342 ROBOTIC SIMPLE PROSTATECTOMY Rene J Sotelo*, Oswaldo Carmona, Rafael Clavijo, Eduardo Banda, Marcelo Miranda, Nelson Palomino, Randy Fagin, Antonio Finelli. Caracas, Venezuela, Bogota, Colombia, Austin, TX, and Toronto, ON, Canada. INTRODUCTION AND OBJECTIVE: Minimally invasive techniques for the treatment of symptomatic benign prostatic hyperplasia (BPH) for large glands are replacing the Gold Standard open surgical approach. The techniques duplicate the principles of open surgery with equivalent results and less morbidity. We describe our initial experience with robotic simple prostatectomy. METHODS: Since January 2007, robotic simple prostatectomy has been performed via a transperitoneal approach in 9 patients by a VLQJOH VXUJHRQ 56 7KHVH SDWLHQWV KDG V\PSWRPDWLF VLJQL¿FDQW BPH and 6 experienced acute urinary retention (AUR). Demographic, perioperative and postoperative outcome data was recorded. RESULTS: Average patient age was 63.2 years (range 56 to 72) with a mean prostate volume of 80.8 ml. The average operative time was 205 minutes (range 120 to 300) and estimated blood loss was 298 ml (range 60 to 800). Hospital stay was 1.4 days (range 1 to 2), average Foley catheter duration was 7 days (range 6 to 9) and the drain was removal after 3.8 days (range 3 to 4). Mean specimen weight on pathological examination was 56.1 gm (range 40 to 64.5). Transfusion was necessary in 1 patient. No complications occurred. Considerable improvement from baseline was noted in IPSS evaluation (preoperative and postoperative, 22 and 7.3, respectively) and Qmax (preoperative and postoperative, 17.8 and 55.5 ml per second, respectively). All patients in AUR recovered voiding function. CONCLUSIONS: Robotic simple prostatectomy is a feasible reproducible procedure. Further experience with a greater number of patients will be required to determine the ultimate role this procedure will have in the management of BPH. (This initial experience has been accepted for publication in the Journal of Urology) Source of Funding: None
V343 TRANS URETHRAL BIPOLAR VAPORIZATION OF PROSTATE IN SALINE (T.U.V.Pis). A NEW RESECTION SYSTEM FOR BENIGN PROSTATIC HYPERPLASIA Michel Naudin*, Didier Pamart, Luc Hourriez. Mons, Belgium. INTRODUCTION AND OBJECTIVE: Bipolar transurethral YDSRUL]DWLRQ RI WKH SURVWDWH LQ VDOLQH LV D QRYHO WHFKQLTXH LQ ZLFK
THE JOURNAL OF UROLOGY®
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
340 GEMCITABINE AND MITOMYCIN INTRAVESICAL THERAPY IN PATIENTS WITH RECURRENT BLADDER CANCER REFRACTORY TO BCG Benjamin N Breyer*, Jared M Whitson, Peter R Carroll, Badrinath R Konety. San Francisco, CA. INTRODUCTION AND OBJECTIVE: Currently, there are few options other than cystectomy for the management of BCG refractory non-muscle invasive bladder cancer. We report our experience with intravesical combination chemotherapy using gemcitabine and mitomycin in such patients. METHODS: The IRB approved UCSF Urologic Oncology Database (UODB) was queried to identify patients with BCG refractory, non-muscle invasive bladder cancer and were treated with gemcitabine and mitomycin. Data was collected regarding patient demographics, and disease information such as previous intravesical therapy, previous F\VWRVFRS\F\WRORJ\UHVXOWVWLPHWRUHFXUUHQFHDQGVLGHHIIHFWSUR¿OH 5HVSRQVHZDVGH¿QHGDVQRUPDOF\WRORJ\F\VWRVFRS\DQGRUELRSV\ Follow-up evaluations were performed at 3 monthly intervals following start of induction therapy. RESULTS: Seven patients who had failed intravesical BCG WKHUDS\ DW OHDVW [ DQG %&* ,QWHUIHURQ ĮE ZHUH WUHDWHG ZLWK D combination of intravesical gemcitabine (1000mg in 50 ml sterile water) followed sequentially by mitomycin (40mg in 20ml sterile water) intravesically every week for 6 weeks (induction). One patient had previous history of G1 Ta without CIS, 3 patients had HG Ta with CIS and 3 patients had HGT1 with CIS. Induction therapy was followed by a maintenance regimen using the same dose of Gemcitabine and Mitomycin once a month for 12 months. 2/7 (29%) patients did not UHVSRQGWRWKHWKHUDS\DQGKDGELRSV\SURYHQWXPRUDWWKH¿UVWIROORZXS cystoscopy 6 weeks after completion of induction. 5/7 (71%) patients demonstrated complete response and have maintained their response at a mean follow-up of 10.3 months (6.3±SD). The therapy was well tolerated. There were no major complications. 2/7 (29%) patients experienced irritative lower urinary tract symptoms which did not require cessation of therapy and 1/7 (14%) experienced a maculopapillary rash that improved with Benadryl. CONCLUSIONS: In patients, with recurrent BCG refractory bladder cancer, intravesical combination chemotherapy with gemcitabine and mitomycin appears to be well tolerated and yields a response in a VLJQL¿FDQWQXPEHURISDWLHQWV/RQJHUIROORZXSLVQHHGHGWRGHWHUPLQH RYHUDOOHI¿FDF\LQSUHYHQWLQJUHFXUUHQFHDQGSURJUHVVLRQ Source of Funding: None
Male Voiding Dysfunction, BPH and Didactic Urological Videos Video Session 1 Sunday, May 18, 2008
10:30 am - 12:30 pm
V341 MODIFIED RETROPUBIC OPEN PROSTATECTOMY USING A VESSEL SEALING SYSTEM Teruhisa Nomura*, Makoto Kawaguchi, Takashi Yamagishi, Hiroshi Nakagomi, Masami Aikawa, Isao Araki, Masayuki Takeda. Yamanashi, Japan. INTRODUCTION AND OBJECTIVE: The surgical treatment options for bladder outlet obstruction caused by benign prostatic hyperplasia have been expanded dramatically with the development of minimally invasive therapies. Retropubic open prostatectomy is, however, still needed to be performed in the patients with severe outlet obstruction caused by marked benign prostatic enlargement with more HI¿FDF\IRUDOOHYLDWLQJWKHV\PSWRPV:HGHYHORSHGDVDIHUDQGHDVLHU technique for capsulotomy in retropubic open prostatectomy using a vessel sealing system. METHODS: A special instrument needed is only Ligasure™ Xtd (Vallylab, Boulder, CO, USA). A 9 cm lower midline incision is SODFHG DQG WKH VSDFH RI 5HW]LXV LV H[SRVHG )RU FDSVXORWRP\ WZR hemostatic absorbable stitches are placed medially on each side of the transverse capsulotomy line estimated. The capsule between the
stitches is minimally incised with an electrocautery to expose adenoma. The blunt and gently curved tip of the Ligasure™ Xtd is inserted beneath the capsule, then the capsule is sealed more than three times at the VDPHSRUWLRQIRUFRPSOHWHKHPRVWDVLVDQGLVGLYLGHGZLWK0HW]HQEDXP scissors. The capsulotomy is completed by extending the incision VXI¿FLHQWO\ODWHUDOO\ZLWKUHSHDWLQJWKHVDPHSURFHGXUH$IWHUUHPRYLQJ DGHQRPDE\EOXQW¿QJHUGLVVHFWLRQKHPRVWDVLVLVFRPSOHWHGDQGWKH bladder neck mucosa is advanced into the prostatic fossa. Finally, the sealed capsule edge is closed by deep and wide stitches using 2-0 Vicryl sutures to avoid post-operative urine leakage. RESULTS: We performed the technique in 6 cases that had urinary retention or more than 100 ml of post-void residual urine. The mean operative time was 146 minutes. The mean blood loss including urine was 542 ml. The mean specimen weight removed was 88.3 g. The capsulotomy was completed within 13 minutes 22 seconds on the average without bleeding from the edge of the capsulotomy. In all cases, no perioperarive complication was seen, although urethral catheters ZHUHUHPRYHGRQWKHWKSRVWRSHUDWLYHGD\DIWHUFRQ¿UPLQJQROHDNDJH by retrograde cystography. The voiding status was excellent excepting urge incontinence in one case post-operatively. CONCLUSIONS: Using the vessel sealing system enables VDIHU DQG HDVLHU VLPSOL¿FDWLRQ RI FDSVXORWRP\ LQ UHWURSXELF RSHQ prostatectomy with minimum hemostatic absorbable stitches on the capsule, that may contribute to reducing the operative time and blood loss. Source of Funding: None
V342 ROBOTIC SIMPLE PROSTATECTOMY Rene J Sotelo*, Oswaldo Carmona, Rafael Clavijo, Eduardo Banda, Marcelo Miranda, Nelson Palomino, Randy Fagin, Antonio Finelli. Caracas, Venezuela, Bogota, Colombia, Austin, TX, and Toronto, ON, Canada. INTRODUCTION AND OBJECTIVE: Minimally invasive techniques for the treatment of symptomatic benign prostatic hyperplasia (BPH) for large glands are replacing the Gold Standard open surgical approach. The techniques duplicate the principles of open surgery with equivalent results and less morbidity. We describe our initial experience with robotic simple prostatectomy. METHODS: Since January 2007, robotic simple prostatectomy has been performed via a transperitoneal approach in 9 patients by a VLQJOH VXUJHRQ 56 7KHVH SDWLHQWV KDG V\PSWRPDWLF VLJQL¿FDQW BPH and 6 experienced acute urinary retention (AUR). Demographic, perioperative and postoperative outcome data was recorded. RESULTS: Average patient age was 63.2 years (range 56 to 72) with a mean prostate volume of 80.8 ml. The average operative time was 205 minutes (range 120 to 300) and estimated blood loss was 298 ml (range 60 to 800). Hospital stay was 1.4 days (range 1 to 2), average Foley catheter duration was 7 days (range 6 to 9) and the drain was removal after 3.8 days (range 3 to 4). Mean specimen weight on pathological examination was 56.1 gm (range 40 to 64.5). Transfusion was necessary in 1 patient. No complications occurred. Considerable improvement from baseline was noted in IPSS evaluation (preoperative and postoperative, 22 and 7.3, respectively) and Qmax (preoperative and postoperative, 17.8 and 55.5 ml per second, respectively). All patients in AUR recovered voiding function. CONCLUSIONS: Robotic simple prostatectomy is a feasible reproducible procedure. Further experience with a greater number of patients will be required to determine the ultimate role this procedure will have in the management of BPH. (This initial experience has been accepted for publication in the Journal of Urology) Source of Funding: None
V343 TRANS URETHRAL BIPOLAR VAPORIZATION OF PROSTATE IN SALINE (T.U.V.Pis). A NEW RESECTION SYSTEM FOR BENIGN PROSTATIC HYPERPLASIA Michel Naudin*, Didier Pamart, Luc Hourriez. Mons, Belgium. INTRODUCTION AND OBJECTIVE: Bipolar transurethral YDSRUL]DWLRQ RI WKH SURVWDWH LQ VDOLQH LV D QRYHO WHFKQLTXH LQ ZLFK