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UP-02.144 Intraoperative and Postoperative Complications Encountered in Patients Undergoing Robotic-Assisted Radical Prostatectomy: An Analysis of 2000 Consecutive Cases
UNMODERATED POSTER SESSIONS
yielded significantly higher cancer detection rates compared to 10-or 12-core strategies. Saturation biopsy in men with previous negative biopsies, have shown cancer detection rates of up to 43% in this high risk population, mainly using a trans-perineal template approach. Most urologists are more familiar with a transrectal approach, hence evaluation of this new technology is warranted. Materials and Methods: We evaluated 41 men with prior negative prostate biopsies, with a further 3D mapping prostate biopsy using a TargetScan® device (Envisioneering Medical Technologies) under general anaesthesia in day surgery. We analysed pre, intra and postoperative variables and recorded complications and performance of the new biopsy system. All patients received prophylactic antibiotic cover. Results: The mean patient age was 64.9 years (Range 54-79) with a mean PSA of 13.25 ng/ml (Range 5.3-79). The mean operative time was 22 minutes (Range 16-35).The patients had received a mean of 1.4 previous biopsies (Range 1-4). The mean number of prostate cores was 21.42 per patient (Range 6-26). Eighteen men had positive biopsies (43.90%) with an average 5.11 positive cores per patient (Range 3-16). The mean percentage of positive cores was 24.56% (Range 4-76%). Complications: urine retention 2/41 (4.87%), UTI within 30 days 3/41 (7.31%). Conclusions: Transrectal 3D mapping biopsies of the prostate can be performed safely with low morbidity and acceptable cancer detection rates.
UP-02.142 Prostate Cancer Primary Topographic Prevalence and Volumetry in 1.000 T1-2 Cases Thüroff S1,2, Chaussy C1,3 1 Krebshilfe E.V., Germany, Depts. of Urology, 2Klinikum München Harlaching, Munich, 3University of Regensburg, Regensburg, Germany Objective: Visually guided or random biopsies and TUR/adenectomy can provide histological material for determination of tumorlocation (topography), tumorvolume (No of positive biopsies) and -aggressiveness (Gleason score) determination. All diagnostic methods have significant limitations. We analyzed a prospective series of transrectal ultrasound guided biopsies and TUR specimen. Methods: Data analysis out of prospective monocentric HIFU database for T1-2, N0, M0 patients. All had 6-24 TRUS guided transrectal
UP-02.142, Table 1. I) Baseline: prostate volumes (cc) for analysis n %
< 11 4 0.5
11-30 342 35.5
31-50 392 41
51-70 137 14
71-90 54 5
>90 34 4
UP-02.142, Table 2. II) TUR gr ⬍ 15 16-25 26-35 36-50 ⬎50
No PCa 217 (45%) 64 (30%) 49 (43%) 20 (27%) 23 (35%)
< 10% PCa 126 (25%) 72 (34%) 29 (25%) 22 (30%) 20 (30%)
11-40%PCa 92 (18%) 36 (17%) 23 (20%) 18 (25%) 13 (25%)
>40%PCa 62 (12%) 40 (19%) 14 (12%) 13 (18%) 10 (15%)
TOTAL 497 (100%) 212 (100%) 115 (100%) 73 (100%) 66 (100%)
1-3mm 110 (11%) 152 (16%) 105 (11%) 94 (10%) 162 (17%) 83 (9%)
>3mm 147 (15%) 178 (18%) 135 (14%) 143 (15%) 169 (18%) 174 (18%)
TOTAL 393 (41%) 540 (56%) 407 (42%) 421 (44%) 548 (57%) 401 (42%)
UP-02.142, Table 3. III) Intrabioptic PCa volume: 1: R base (n /%) 2: R middle 3: R apex 4: L apex 5: L middle 6: L base
< 1mm 136 (14%) 210 (22%) 167 (17%) 184 (19%) 217 (23%) 144 (15%)
prostate staging biopsies. All biopsies were correlated to 6 major topographic locations (right/left/apex/middle/base). In a second analysis patients with TUR and biopsies were analyzed the same way. Results: Conclusion: Prostate cancer detection rate by TUR in a cohort of 963 patients with biopsy proven PCa (100%) was between 55% and 73%, even radicaly resected tissue volume was up to 71% of the initial total prostatic volume. ● Transrectal bioptic primary prostate cancer distribution showed to have a prevalence to the lateral-middle zones of the prostate. ● No differences in primary PCa localisation between apex and base, right or left was detected. ● Regarding tumor volumetry there was no prevalence in tumor size or tumor location.
UP-02.143 Major Complications and Associated Risk Factors of Transrectal Ultrasound Guided Prostate Needle Biopsy: A Retrospective Study of 611 Cases Uesugi T, Tsugawa M Dept. of Urology, Okayama Citizen’s Hospital, Okayama, Japan Introduction and Objective: Complications from transrectal ultrasound (TRUS) guided prostate needle biopsy are occasionally encountered in the daily practice of urologists. We tried to determine the associated risk factors of patients who suffered from major complications which
UROLOGY 78 (Supplement 3A), September 2011
required hospitalization after TRUS guided prostate needle biopsies. Materials and Methods: In a single-center retrospective study of 611 TRUS guided prostate biopsies performed between June 2001 and December 2010. We defined major complications as patients with complications that needed hospitalization. We analyzed the association between biopsy complications and suspected factors, including age, prostate volume, selection of prophylactic antibiotics, biopsy core numbers (range 6 to 10 cores) and use of antithrombogenic drug. Results: In all, 86 patients took antithrombogenic drug while the other 525 did not. There were 21 cases (3.4%) with major complication. These major complications were categorized as acute prostatitis (2.8%), rectal bleeding (0.33%), urinary retention (0.16%) and sepsis (0.16%). No factor was associated with major complications after prostate biopsy. Conclusions: TRUS guided prostate needle biopsy is a safe diagnostic tool in most elderly males . In particular, there is no evidence that antithrombogenic drug needs to discontinued before prostate biopsy.
UP-02.144 Intraoperative and Postoperative Complications Encountered in Patients Undergoing Robotic-Assisted Radical Prostatectomy: An Analysis of 2000 Consecutive Cases Labanaris A, Zugor V, Witt J Dept. of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius
S309
UNMODERATED POSTER SESSIONS
Medical Center, Gronau, Germany
UP-02.145, Table 1.
Introduction and Objectives: The objective of this study is to assess the intraoperative and postoperative complications encountered in patients undergoing robotic prostatectomy by analysing 2000 consecutive cases. Materials and Methods: The records of N⫽2000 men who underwent RALP at a certified robotic institute from February 2006 to April 2010 were retrospectively reviewed. All patients were assessed in detail for intraoperative as well as postoperative complications by using the Clavien’s classification. Further parameters analyzed included: age, body-mass index (BMI), prostate size, PSA values, bilateral neurovascular bundle (NVB) preservation, lymph node dissection, pathologic stage, previous abdominal surgery, length of catheterisation, blood loss and skin-to-skin operative time. Results: The median age of the patients was 63 years. The median BMI was 26.7 kg/m2, median prostate weight was 56.1 gr. and median PSA value was 10.3 ng/ml. A bilateral NVB preservation was performed in 65.7% of cases and lymph nodes were dissected in 22% of cases. An organ-confined disease in was noted in 73.5% and extraprostatic extension in 25.2%. Previous abdominal surgery was noted in 8% of cases, the length of catheterisation was 5.5 days, the estimated blood loss was 160ml and the median operative time was 156 min. The overall intraoperative complication rate was 2.5% with bladder lesions (1%), intestine lesions (0.7%), anastomosis rupture (0.2%) and external iliac vein perforation (0.2%) dominating. A conversion to open surgery took place in N⫽3 cases (0.15%). The overall postoperative complication rate was 12.7%. Minor (Clavien’s grade I–IIIa) and major postoperative complications (Clavien’s grade IIIb-IVa) were noted in 11.4% and 1.3% respectively. Minor complications that dominated were extravasation and re-cystography in 4.2% of cases, anaemia requiring transfusion in 0.6% and symptomatic lymphocele requiring catheter drainage in 0.3%. Major complications that dominated were open re-operations in 0.7% of cases (n⫽14) due to bleeding (0.4%) and intestine perforation (0.3%). n⫽4 patients (0.2%) exhibited acute renal failure, and n⫽1 patient (0.05%) past away 2 weeks after his discharge due to acute myocardial infarction. Conclusion: In experienced hands, RALP is a safe and effective surgical procedure with very low morbidity and mortality.
Parameters Patients Age (median) BMI (median) Prostate size (median) PSA (median) NVB preservation Gleason score ⬍7 ⫽7 ⬎7 Stage Confined disease Extraprostatic extension % of tumor in specimen Positive margins Blood loss (median) Operative time (median) Minor complications Major complications
S310
Prostate <50 gr. N⫽753 (45.1%) 62 26.5 kg/m2 39.5gr. 9.8% 65.3%
Prostate 50-80 gr. N⫽663 (39.7%) 64 26.8 kg/m2 60.5gr. 11.2 ng/ml 70.2%
Prostate >80.gr. N⫽251 (15.2%) 66 27.1 kg/m2 111.7gr. 12.3 ng/ml 65.6%
39.6% 50.4% 10%
43.1% 46.1% 10.8%
56.3% 33.1% 11.6%
71.1% 28.9%
72.6% 27.4%
78.1% 21.9%
16.2% 9.3% 144ml 142 min 13.1% 1.1%
16.8% 7.2% 161 ml 146 min 12.1% 0.8%
14.4% 5.2% 189 ml 183 min 11.6% 1.9%
UP-02.145 The Impact of Prostate Size on Surgical, Oncologic and Functional Outcomes of Patients Undergoing Robotic Prostatectomy Labanaris A, Zugor V, Witt J Dept. of Urology and Pediatric Urology Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany Introduction and Objectives: Patients with larger prostates undergoing robotassisted radical prostatectomy (RARP) can pose increased challenges even to experienced operators. The objective of this study is to assess the impact of prostate size on surgical, oncologic and functional outcomes in patients undergoing RARP. Materials and Methods: The records of N⫽2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. The patients were categorized into 3 groups according to their prostate size (⬍50gr., 50-80gr., ⬎80gr.) and a comparison was performed among these patient cohorts. Patients with neo-adjuvant hormone therapy, radiation or previous transurethral prostate resection (TUR-P) were excluded from the study. The parameters analyzed included: age, body-mass index (BMI), prostate size, PSA values, bilateral neurovascular bundle (NVB) preservation, Gleason score, pathologic stage, positive surgical margins (PSM), percentage of prostate cancer (PCa) found in the specimen, blood loss, minor (Clavien’s grade I–IIIa) and major complications (Clavien’s grade IIIb-IVa), skin-to-skin operative time, continence (defined as no pad use) and potency (de-
fined as erections sufficient for penetration with or without phosphodiesterase inhibitors) in 12 months. Results: N⫽ 1667 patients were identified. The characteristics of the patients are listed in the Table. A statistical difference of the parameters analyzed was observed in lower stage (p⬍0.05), lower Gleason sums (p⬍0.05), PSM (p⬍0.05) and operative time (p⬍0.001). There was no significant difference regarding functional outcomes. At 12 months, 92.3% / 92.1% / 89.6% were continent and 66.3% /67.1% / 65.2% of preoperative potent patients who underwent NVB preservation were potent. Conclusions: Apart from a prolonged operative time, patients with a large prostate undergoing RARP exhibit similar surgical and functional outcomes as well as better oncologic outcomes in comparison to patients with a small or medium prostate size. Additionally, PSM rates are significantly lower in this cohort of patients.
UP-02.146 Meanings of the Polyunsaturated Fatty Acid in Patients with Prostate Cancer Yamada D, Horikawa Y, Koizumi F Dept. of Urology, Mitoyo General Hospital, Kanonji, Japan Introduction and Objective: In Japan, the number of prostate cancer (PC) patients has been increasing remarkably. The change of Japanese eating habits is considered as one of the causes. Actually, in late years the intake of fishes or soy beans decreases in the Japanese.
UROLOGY 78 (Supplement 3A), September 2011
yielded significantly higher cancer detection rates compared to 10-or 12-core strategies. Saturation biopsy in men with previous negative biopsies, have shown cancer detection rates of up to 43% in this high risk population, mainly using a trans-perineal template approach. Most urologists are more familiar with a transrectal approach, hence evaluation of this new technology is warranted. Materials and Methods: We evaluated 41 men with prior negative prostate biopsies, with a further 3D mapping prostate biopsy using a TargetScan® device (Envisioneering Medical Technologies) under general anaesthesia in day surgery. We analysed pre, intra and postoperative variables and recorded complications and performance of the new biopsy system. All patients received prophylactic antibiotic cover. Results: The mean patient age was 64.9 years (Range 54-79) with a mean PSA of 13.25 ng/ml (Range 5.3-79). The mean operative time was 22 minutes (Range 16-35).The patients had received a mean of 1.4 previous biopsies (Range 1-4). The mean number of prostate cores was 21.42 per patient (Range 6-26). Eighteen men had positive biopsies (43.90%) with an average 5.11 positive cores per patient (Range 3-16). The mean percentage of positive cores was 24.56% (Range 4-76%). Complications: urine retention 2/41 (4.87%), UTI within 30 days 3/41 (7.31%). Conclusions: Transrectal 3D mapping biopsies of the prostate can be performed safely with low morbidity and acceptable cancer detection rates.
UP-02.142 Prostate Cancer Primary Topographic Prevalence and Volumetry in 1.000 T1-2 Cases Thüroff S1,2, Chaussy C1,3 1 Krebshilfe E.V., Germany, Depts. of Urology, 2Klinikum München Harlaching, Munich, 3University of Regensburg, Regensburg, Germany Objective: Visually guided or random biopsies and TUR/adenectomy can provide histological material for determination of tumorlocation (topography), tumorvolume (No of positive biopsies) and -aggressiveness (Gleason score) determination. All diagnostic methods have significant limitations. We analyzed a prospective series of transrectal ultrasound guided biopsies and TUR specimen. Methods: Data analysis out of prospective monocentric HIFU database for T1-2, N0, M0 patients. All had 6-24 TRUS guided transrectal
UP-02.142, Table 1. I) Baseline: prostate volumes (cc) for analysis n %
< 11 4 0.5
11-30 342 35.5
31-50 392 41
51-70 137 14
71-90 54 5
>90 34 4
UP-02.142, Table 2. II) TUR gr ⬍ 15 16-25 26-35 36-50 ⬎50
No PCa 217 (45%) 64 (30%) 49 (43%) 20 (27%) 23 (35%)
< 10% PCa 126 (25%) 72 (34%) 29 (25%) 22 (30%) 20 (30%)
11-40%PCa 92 (18%) 36 (17%) 23 (20%) 18 (25%) 13 (25%)
>40%PCa 62 (12%) 40 (19%) 14 (12%) 13 (18%) 10 (15%)
TOTAL 497 (100%) 212 (100%) 115 (100%) 73 (100%) 66 (100%)
1-3mm 110 (11%) 152 (16%) 105 (11%) 94 (10%) 162 (17%) 83 (9%)
>3mm 147 (15%) 178 (18%) 135 (14%) 143 (15%) 169 (18%) 174 (18%)
TOTAL 393 (41%) 540 (56%) 407 (42%) 421 (44%) 548 (57%) 401 (42%)
UP-02.142, Table 3. III) Intrabioptic PCa volume: 1: R base (n /%) 2: R middle 3: R apex 4: L apex 5: L middle 6: L base
< 1mm 136 (14%) 210 (22%) 167 (17%) 184 (19%) 217 (23%) 144 (15%)
prostate staging biopsies. All biopsies were correlated to 6 major topographic locations (right/left/apex/middle/base). In a second analysis patients with TUR and biopsies were analyzed the same way. Results: Conclusion: Prostate cancer detection rate by TUR in a cohort of 963 patients with biopsy proven PCa (100%) was between 55% and 73%, even radicaly resected tissue volume was up to 71% of the initial total prostatic volume. ● Transrectal bioptic primary prostate cancer distribution showed to have a prevalence to the lateral-middle zones of the prostate. ● No differences in primary PCa localisation between apex and base, right or left was detected. ● Regarding tumor volumetry there was no prevalence in tumor size or tumor location.
UP-02.143 Major Complications and Associated Risk Factors of Transrectal Ultrasound Guided Prostate Needle Biopsy: A Retrospective Study of 611 Cases Uesugi T, Tsugawa M Dept. of Urology, Okayama Citizen’s Hospital, Okayama, Japan Introduction and Objective: Complications from transrectal ultrasound (TRUS) guided prostate needle biopsy are occasionally encountered in the daily practice of urologists. We tried to determine the associated risk factors of patients who suffered from major complications which
UROLOGY 78 (Supplement 3A), September 2011
required hospitalization after TRUS guided prostate needle biopsies. Materials and Methods: In a single-center retrospective study of 611 TRUS guided prostate biopsies performed between June 2001 and December 2010. We defined major complications as patients with complications that needed hospitalization. We analyzed the association between biopsy complications and suspected factors, including age, prostate volume, selection of prophylactic antibiotics, biopsy core numbers (range 6 to 10 cores) and use of antithrombogenic drug. Results: In all, 86 patients took antithrombogenic drug while the other 525 did not. There were 21 cases (3.4%) with major complication. These major complications were categorized as acute prostatitis (2.8%), rectal bleeding (0.33%), urinary retention (0.16%) and sepsis (0.16%). No factor was associated with major complications after prostate biopsy. Conclusions: TRUS guided prostate needle biopsy is a safe diagnostic tool in most elderly males . In particular, there is no evidence that antithrombogenic drug needs to discontinued before prostate biopsy.
UP-02.144 Intraoperative and Postoperative Complications Encountered in Patients Undergoing Robotic-Assisted Radical Prostatectomy: An Analysis of 2000 Consecutive Cases Labanaris A, Zugor V, Witt J Dept. of Urology and Pediatric Urology, Prostate Center Northwest, St. Antonius
S309
UNMODERATED POSTER SESSIONS
Medical Center, Gronau, Germany
UP-02.145, Table 1.
Introduction and Objectives: The objective of this study is to assess the intraoperative and postoperative complications encountered in patients undergoing robotic prostatectomy by analysing 2000 consecutive cases. Materials and Methods: The records of N⫽2000 men who underwent RALP at a certified robotic institute from February 2006 to April 2010 were retrospectively reviewed. All patients were assessed in detail for intraoperative as well as postoperative complications by using the Clavien’s classification. Further parameters analyzed included: age, body-mass index (BMI), prostate size, PSA values, bilateral neurovascular bundle (NVB) preservation, lymph node dissection, pathologic stage, previous abdominal surgery, length of catheterisation, blood loss and skin-to-skin operative time. Results: The median age of the patients was 63 years. The median BMI was 26.7 kg/m2, median prostate weight was 56.1 gr. and median PSA value was 10.3 ng/ml. A bilateral NVB preservation was performed in 65.7% of cases and lymph nodes were dissected in 22% of cases. An organ-confined disease in was noted in 73.5% and extraprostatic extension in 25.2%. Previous abdominal surgery was noted in 8% of cases, the length of catheterisation was 5.5 days, the estimated blood loss was 160ml and the median operative time was 156 min. The overall intraoperative complication rate was 2.5% with bladder lesions (1%), intestine lesions (0.7%), anastomosis rupture (0.2%) and external iliac vein perforation (0.2%) dominating. A conversion to open surgery took place in N⫽3 cases (0.15%). The overall postoperative complication rate was 12.7%. Minor (Clavien’s grade I–IIIa) and major postoperative complications (Clavien’s grade IIIb-IVa) were noted in 11.4% and 1.3% respectively. Minor complications that dominated were extravasation and re-cystography in 4.2% of cases, anaemia requiring transfusion in 0.6% and symptomatic lymphocele requiring catheter drainage in 0.3%. Major complications that dominated were open re-operations in 0.7% of cases (n⫽14) due to bleeding (0.4%) and intestine perforation (0.3%). n⫽4 patients (0.2%) exhibited acute renal failure, and n⫽1 patient (0.05%) past away 2 weeks after his discharge due to acute myocardial infarction. Conclusion: In experienced hands, RALP is a safe and effective surgical procedure with very low morbidity and mortality.
Parameters Patients Age (median) BMI (median) Prostate size (median) PSA (median) NVB preservation Gleason score ⬍7 ⫽7 ⬎7 Stage Confined disease Extraprostatic extension % of tumor in specimen Positive margins Blood loss (median) Operative time (median) Minor complications Major complications
S310
Prostate <50 gr. N⫽753 (45.1%) 62 26.5 kg/m2 39.5gr. 9.8% 65.3%
Prostate 50-80 gr. N⫽663 (39.7%) 64 26.8 kg/m2 60.5gr. 11.2 ng/ml 70.2%
Prostate >80.gr. N⫽251 (15.2%) 66 27.1 kg/m2 111.7gr. 12.3 ng/ml 65.6%
39.6% 50.4% 10%
43.1% 46.1% 10.8%
56.3% 33.1% 11.6%
71.1% 28.9%
72.6% 27.4%
78.1% 21.9%
16.2% 9.3% 144ml 142 min 13.1% 1.1%
16.8% 7.2% 161 ml 146 min 12.1% 0.8%
14.4% 5.2% 189 ml 183 min 11.6% 1.9%
UP-02.145 The Impact of Prostate Size on Surgical, Oncologic and Functional Outcomes of Patients Undergoing Robotic Prostatectomy Labanaris A, Zugor V, Witt J Dept. of Urology and Pediatric Urology Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany Introduction and Objectives: Patients with larger prostates undergoing robotassisted radical prostatectomy (RARP) can pose increased challenges even to experienced operators. The objective of this study is to assess the impact of prostate size on surgical, oncologic and functional outcomes in patients undergoing RARP. Materials and Methods: The records of N⫽2000 men who underwent RARP from February 2006 to April 2010 were retrospectively reviewed. The patients were categorized into 3 groups according to their prostate size (⬍50gr., 50-80gr., ⬎80gr.) and a comparison was performed among these patient cohorts. Patients with neo-adjuvant hormone therapy, radiation or previous transurethral prostate resection (TUR-P) were excluded from the study. The parameters analyzed included: age, body-mass index (BMI), prostate size, PSA values, bilateral neurovascular bundle (NVB) preservation, Gleason score, pathologic stage, positive surgical margins (PSM), percentage of prostate cancer (PCa) found in the specimen, blood loss, minor (Clavien’s grade I–IIIa) and major complications (Clavien’s grade IIIb-IVa), skin-to-skin operative time, continence (defined as no pad use) and potency (de-
fined as erections sufficient for penetration with or without phosphodiesterase inhibitors) in 12 months. Results: N⫽ 1667 patients were identified. The characteristics of the patients are listed in the Table. A statistical difference of the parameters analyzed was observed in lower stage (p⬍0.05), lower Gleason sums (p⬍0.05), PSM (p⬍0.05) and operative time (p⬍0.001). There was no significant difference regarding functional outcomes. At 12 months, 92.3% / 92.1% / 89.6% were continent and 66.3% /67.1% / 65.2% of preoperative potent patients who underwent NVB preservation were potent. Conclusions: Apart from a prolonged operative time, patients with a large prostate undergoing RARP exhibit similar surgical and functional outcomes as well as better oncologic outcomes in comparison to patients with a small or medium prostate size. Additionally, PSM rates are significantly lower in this cohort of patients.
UP-02.146 Meanings of the Polyunsaturated Fatty Acid in Patients with Prostate Cancer Yamada D, Horikawa Y, Koizumi F Dept. of Urology, Mitoyo General Hospital, Kanonji, Japan Introduction and Objective: In Japan, the number of prostate cancer (PC) patients has been increasing remarkably. The change of Japanese eating habits is considered as one of the causes. Actually, in late years the intake of fishes or soy beans decreases in the Japanese.
UROLOGY 78 (Supplement 3A), September 2011