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UP-2.145: Does Transection of the Spermatic Cord Lower the Incidence of Inguinal Hernia After Radical Retropubic Prostatectomy?
UNMODERATED POSTER SESSIONS
cer. The ASTRO definition for failure (3 consecutive PSA elevations without later decrease “known as the PSA hump”), was employed for this report. In all, less than 2% of men were defined as failures, along the entire 8-year follow up. The cummalative biochemical free survival is presented in the figure. Conclusion: In our experience, 125Ibrachytherapy is an excellent mode of treatment for localized prostate cancer, with very low failure rates. Our results compare very favorably with reports on radical prostatectomy and external beam radiotherapy as well as other brachytherapy groups. Among others, we do acknowledge our strict inclusion criteria. The effect of adjuvant/neoadjuvant hormonotherapy for gland downsizing will be discussed.
was 31% at 12 months. 20/33 (61%) patients achieved PSA nadir of ⬍0.1. 1 patient had re-treatment for recurrence and developed urethral stricture requiring supra pubic catheterisation. Biochemical recurrence was defined as PSA ⬎/⫽ 0.2. The biochemical recurrence free survival at 12 and 24 months were 54% and 43% respectively. 5 (15%) patients had disease progression and overall disease specific survival was 97%. Conclusions: Cryotherapy as salvage treatment post radiation failure has high overall complication rate. However, it has potential to cure or delay in hormonal treatment for selected patients. Furthermore, randomised trial with long term follow up is required to assess efficacy of cryotherapy as salvage treatment.
UP-2.144 Experience with Salvage Cryotherapy for Radio Recurrent Prostate Cancer Mevcha A, Kumar V, Probert J, Gillatt D Bristol Urology Institute, Bristol, UK
UP-2.145 Does Transection of the Spermatic Cord Lower the Incidence of Inguinal Hernia After Radical Retropubic Prostatectomy? Miyaji Y1, Kobuke M2, Jo Y1, Fujii T1, Kaifu M1, Hara R1, Kusaka N2, Yokoyama T1, Fujita R2, Nagai A1 1 Department of Urology, Kawasaki Medical School, Kurashiki, Japan; 2Department of Urology, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
Introduction and Objective: Localised recurrence of prostate cancer after radiation treatment can be treated with salvage radical prostatectomy or focal treatment such as cryotherapy. The salvage cryotherapy can completely ablate the recurrent tumour and has curative potential. We reviewed functional and oncological outcome of salvage cryotherapy to assess efficacy in patients who had PSA recurrence following primary radiotherapy treatment for localised prostate cancer. Materials and Methods: We retrospectively reviewed the data for the patients who had salvage cryotherapy from June 2004 to July 2008. The data were obtained from Local Network Cancer Registry and details were collected from case notes, Hospital Episode Statistics, Multi Disciplinary Team data set and pathology reporting system. Results: Total of 33 patients received salvage cryotherapy during study period. The age range was 59 to 77 years (mean 68 years). The time for biochemical recurrence vary from 4 to 8 years post primary radiotherapy. All patients had biopsy proven recurrence. MRI & bone scan were performed to ensure localised disease. Complications seen in 21 (64%) patients included stricture/obstruction (7), UTI (3), haematuria (3), urinary urgency/ incontinence (5), rectal/perineal pain (10), recto-urethral fistula (1). One patient had bladder perforation requiring drainage under radiological guidance immediately after procedure. 16 out of 33 patients were treated for ED. The potency rate
Introduction and Objective: Inguinal hernias occur in 12% to 21% of men within two years after radical retropubic prostatectomy (RRP). The purpose of the present study was to compare the incidence of hernias after RRP with or without transection of the spermatic cord. Materials and Methods: Between March 2000 and March 2006, 150 consecutive patients underwent RRP in Iwakuni Clinical Center. The spermatic cords were spared (cord-sparing group) in all cases. During the same periods, 117 consecutive men who underwent RRP in Kawasaki Medical School had bilateral spermatic cord transection (cord transection group). We reviewed the medical charts and a questionnaire for postoperative symptoms in the scrotal contents retrospectively and evaluated the incidence and risk factors of inguinal hernia after RRP. Results: The median periods of follow-up and the incidence of postoperative inguinal hernias were 43 months and 40 months, and 16.0% (24 of 150) and 0.9% (1 of 117) in the cord-sparing group and cord transection group, respectively. The incidence of hernias after RRP in the cord transection group was significantly lower than that in the cord-sparing group
UROLOGY 74 (Supplment 4A), October 2009
(p⬍0.001). Among 24 patients in the cord-sparing group who developed postoperative hernia, 21 had an ipsilateral hernia and 3 bilateral hernias. of the 27 hernias, 17 (63.0%) were indirect hernias, 4 were direct, and 6 were unknown. Twenty-four (88.9%) hernias developed within two years. Multivariate Cox proportional hazard analysis revealed that the past history of the inguinal hernia, cord-sparing group (HR 13.9, p⫽0.011), postoperative anastomotic stricture and age over 70 years were significant risk factors for the incidence of inguinal hernia. In the transection cord group, 23 (19.7%) patients complained of ipsilateral or bilateral orchialgia and 18 (15.4%) patients developed hydrocele of the testis. In the other cordsparing group, eight (5.3%) patients complained of orchialgia and three (2.0%) patients developed hydrocele. The incidence of both orchialgia and hydrocele after RRP in the cord transection group was significantly higher than that in the cord-sparing group. However, all of them were detected on close observation and no treatment was necessary. Conclusions: We suggest that transection of the spermatic cord arrests the passage of the peritoneal sac into the internal inguinal canal and thereby prevents the occurrence of inguinal hernia after radical retropubic prostatectomy, in spite of the occurrence of some uncomfortable symptoms in the scrotum.
UP-2.146 The Clinico-Pathologic Patterns of Prostatic Diseases and Prostate Cancer in Saudi Patients Mosli H1, Abdel-Meguid T1, Al-Maghrabi J1,2, Kamal W1, Saadah H2, Farsi H1,2 1 Departments of Urology and Pathology, King Abdulaziz University Medical City, Jeddah; 2King Faisal Specialist Hospital, Jeddah, Saudi Arabia Introduction and Objectives: To determine the clinico-pathologic patterns of prostatic diseases in Saudi patients, with special emphasis on prostate cancer. Materials and Methods: The hospitals of King Abdulaziz University Medical City and King Faisal Specialist hospital are tertiary care teaching hospitals located in Jeddah, Saudi Arabia. The medical records of all patients who underwent histopathological examinations of their prostatic specimens in both hospitals during the period from June 2003-June 2008 were reviewed retrospectively. The age, indications for biopsy, histological diagnosis, Gleason grading of the cancer encoun-
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cer. The ASTRO definition for failure (3 consecutive PSA elevations without later decrease “known as the PSA hump”), was employed for this report. In all, less than 2% of men were defined as failures, along the entire 8-year follow up. The cummalative biochemical free survival is presented in the figure. Conclusion: In our experience, 125Ibrachytherapy is an excellent mode of treatment for localized prostate cancer, with very low failure rates. Our results compare very favorably with reports on radical prostatectomy and external beam radiotherapy as well as other brachytherapy groups. Among others, we do acknowledge our strict inclusion criteria. The effect of adjuvant/neoadjuvant hormonotherapy for gland downsizing will be discussed.
was 31% at 12 months. 20/33 (61%) patients achieved PSA nadir of ⬍0.1. 1 patient had re-treatment for recurrence and developed urethral stricture requiring supra pubic catheterisation. Biochemical recurrence was defined as PSA ⬎/⫽ 0.2. The biochemical recurrence free survival at 12 and 24 months were 54% and 43% respectively. 5 (15%) patients had disease progression and overall disease specific survival was 97%. Conclusions: Cryotherapy as salvage treatment post radiation failure has high overall complication rate. However, it has potential to cure or delay in hormonal treatment for selected patients. Furthermore, randomised trial with long term follow up is required to assess efficacy of cryotherapy as salvage treatment.
UP-2.144 Experience with Salvage Cryotherapy for Radio Recurrent Prostate Cancer Mevcha A, Kumar V, Probert J, Gillatt D Bristol Urology Institute, Bristol, UK
UP-2.145 Does Transection of the Spermatic Cord Lower the Incidence of Inguinal Hernia After Radical Retropubic Prostatectomy? Miyaji Y1, Kobuke M2, Jo Y1, Fujii T1, Kaifu M1, Hara R1, Kusaka N2, Yokoyama T1, Fujita R2, Nagai A1 1 Department of Urology, Kawasaki Medical School, Kurashiki, Japan; 2Department of Urology, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
Introduction and Objective: Localised recurrence of prostate cancer after radiation treatment can be treated with salvage radical prostatectomy or focal treatment such as cryotherapy. The salvage cryotherapy can completely ablate the recurrent tumour and has curative potential. We reviewed functional and oncological outcome of salvage cryotherapy to assess efficacy in patients who had PSA recurrence following primary radiotherapy treatment for localised prostate cancer. Materials and Methods: We retrospectively reviewed the data for the patients who had salvage cryotherapy from June 2004 to July 2008. The data were obtained from Local Network Cancer Registry and details were collected from case notes, Hospital Episode Statistics, Multi Disciplinary Team data set and pathology reporting system. Results: Total of 33 patients received salvage cryotherapy during study period. The age range was 59 to 77 years (mean 68 years). The time for biochemical recurrence vary from 4 to 8 years post primary radiotherapy. All patients had biopsy proven recurrence. MRI & bone scan were performed to ensure localised disease. Complications seen in 21 (64%) patients included stricture/obstruction (7), UTI (3), haematuria (3), urinary urgency/ incontinence (5), rectal/perineal pain (10), recto-urethral fistula (1). One patient had bladder perforation requiring drainage under radiological guidance immediately after procedure. 16 out of 33 patients were treated for ED. The potency rate
Introduction and Objective: Inguinal hernias occur in 12% to 21% of men within two years after radical retropubic prostatectomy (RRP). The purpose of the present study was to compare the incidence of hernias after RRP with or without transection of the spermatic cord. Materials and Methods: Between March 2000 and March 2006, 150 consecutive patients underwent RRP in Iwakuni Clinical Center. The spermatic cords were spared (cord-sparing group) in all cases. During the same periods, 117 consecutive men who underwent RRP in Kawasaki Medical School had bilateral spermatic cord transection (cord transection group). We reviewed the medical charts and a questionnaire for postoperative symptoms in the scrotal contents retrospectively and evaluated the incidence and risk factors of inguinal hernia after RRP. Results: The median periods of follow-up and the incidence of postoperative inguinal hernias were 43 months and 40 months, and 16.0% (24 of 150) and 0.9% (1 of 117) in the cord-sparing group and cord transection group, respectively. The incidence of hernias after RRP in the cord transection group was significantly lower than that in the cord-sparing group
UROLOGY 74 (Supplment 4A), October 2009
(p⬍0.001). Among 24 patients in the cord-sparing group who developed postoperative hernia, 21 had an ipsilateral hernia and 3 bilateral hernias. of the 27 hernias, 17 (63.0%) were indirect hernias, 4 were direct, and 6 were unknown. Twenty-four (88.9%) hernias developed within two years. Multivariate Cox proportional hazard analysis revealed that the past history of the inguinal hernia, cord-sparing group (HR 13.9, p⫽0.011), postoperative anastomotic stricture and age over 70 years were significant risk factors for the incidence of inguinal hernia. In the transection cord group, 23 (19.7%) patients complained of ipsilateral or bilateral orchialgia and 18 (15.4%) patients developed hydrocele of the testis. In the other cordsparing group, eight (5.3%) patients complained of orchialgia and three (2.0%) patients developed hydrocele. The incidence of both orchialgia and hydrocele after RRP in the cord transection group was significantly higher than that in the cord-sparing group. However, all of them were detected on close observation and no treatment was necessary. Conclusions: We suggest that transection of the spermatic cord arrests the passage of the peritoneal sac into the internal inguinal canal and thereby prevents the occurrence of inguinal hernia after radical retropubic prostatectomy, in spite of the occurrence of some uncomfortable symptoms in the scrotum.
UP-2.146 The Clinico-Pathologic Patterns of Prostatic Diseases and Prostate Cancer in Saudi Patients Mosli H1, Abdel-Meguid T1, Al-Maghrabi J1,2, Kamal W1, Saadah H2, Farsi H1,2 1 Departments of Urology and Pathology, King Abdulaziz University Medical City, Jeddah; 2King Faisal Specialist Hospital, Jeddah, Saudi Arabia Introduction and Objectives: To determine the clinico-pathologic patterns of prostatic diseases in Saudi patients, with special emphasis on prostate cancer. Materials and Methods: The hospitals of King Abdulaziz University Medical City and King Faisal Specialist hospital are tertiary care teaching hospitals located in Jeddah, Saudi Arabia. The medical records of all patients who underwent histopathological examinations of their prostatic specimens in both hospitals during the period from June 2003-June 2008 were reviewed retrospectively. The age, indications for biopsy, histological diagnosis, Gleason grading of the cancer encoun-
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