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Urological Oncology: Testis Cancer
1280
LAPAROSCOPY/NEW TECHNOLOGY
Laparoscopy/New Technology Use of a Novel Absorbable Barbed Plastic Surgical Suture Enables a “Self-Cinching” Technique of Vesicourethral Anastomosis During Robot-Assisted Prostatectomy and Improves Anastomotic Times A. K. Tewari, A. Srivastava, P. Sooriakumaran, A. Slevin, S. Grover, O. Waldman, S. Rajan, M. Herman, R. Berryhill, Jr. and R. Leung LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York J Endourol 2010; 24: 1645–1650.
Purpose: To demonstrate a novel technique of self-cinching anastomosis using a barbed and looped suture during robot-assisted radical prostatectomy (RARP). Patients and Methods: This is a feasibility study of 50 consecutive patients who underwent this novel self-cinching anastomotic technique using a V-Loc™ 180 absorbable barbed suture after RARP for clinically localized prostate cancer. The results were then compared with 50 consecutive patients who underwent RARP by the same surgeon before this new technique. We examined whether this novel technique had any effects on posterior reconstruction time, vesicourethral anastomosis time, and thus total reconstruction and operative time by inference. Results: The V-Loc 180 group had significantly shorter posterior reconstruction (40 seconds vs 60 seconds; p ⱕ0.001) and vesicourethral anastomotic times (7 min vs 12 min; p ⱕ0.001). By inference, this meant that total reconstruction and operative times were also significantly less (8 minutes vs 13.5 min; p ⱕ0.001 and 106 min vs 114.5 minutes; p ⱕ0.001, respectively). Conclusion: We have shown that this technique is feasible and improves posterior reconstruction and anastomotic times. Further follow-up will determine any benefits of this technique on anastomotic urinary leak rates, continence, and catheter removal times. Editorial Comment: Barbed sutures that obviate the need for an assistant to follow and hold tension manually on a running suture have been available for several years. Their applicability to urology had previously been limited by the availability of needle type and size, although with new smaller tapered needles and the increasing use of laparoscopic reconstructive procedures their advantage becomes obvious. Many urological surgeons, including myself, have been using these sutures routinely for robotic/laparoscopic vesicourethral anastomosis and partial nephrectomy renorrhaphy. The ease of maintaining tension and tissue approximation facilitate these complex tasks. Jeffrey A. Cadeddu, M.D.
Urological Oncology: Testis Cancer Comparison of Low Dose With Standard Dose Abdominal/Pelvic Multidetector CT in Patients With Stage 1 Testicular Cancer Under Surveillance M. E. O’Malley, P. Chung, M. Haider, H. J. Jang, K. Jhaveri, K. Khalili, T. Panzarella and P. Warde Joint Department of Medical Imaging, Princess Margaret Hospital, Toronto, Ontario, Canada Eur Radiol 2010; 20: 1624 –1630.
Purpose: To compare the image quality and acceptability of a low dose with those of standard dose abdominal/pelvic multidetector CT in patients with stage 1 testicular cancer managed by surveillance.
BLADDER, PENIS AND URETHRAL CANCER, AND BASIC PRINCIPLES OF ONCOLOGY
Methods: One hundred patients (median age 31 years; range 19 – 83 years), 79 with seminoma and 21 with non-seminoma, underwent abdominal/pelvic imaging with low and standard dose protocols on 64-slice multidetector CT. Three reviewers independently evaluated images for noise and diagnostic quality on a 5-point scale and for diagnostic acceptability. Results: On average, each reader scored noise and diagnostic quality of standard dose images significantly better than corresponding low dose images (p ⬍0.0001). One reader found all CT examinations acceptable; two readers each found 1/100 (1%) low dose examinations unacceptable. Median and mean dose-length product for low and standard dose protocols were 416.0 and 452.2 (range 122.9 –913.4) and 931.9 and 999.8 (range 283.8 – 1,987.7) mGy cm, respectively. Conclusions: The low dose protocol provided diagnostically acceptable images for at least 99% of patients and achieved mean dose reduction of 55% compared with the standard dose protocol. Editorial Comment: As surveillance has become more commonplace for patients with low stage nonseminomatous testis tumors and most patients with seminoma, increased interest has been focused on the effects of computerized tomography. With heightened awareness regarding the potential risks of low level ionizing radiation from CT, low dose CT protocols have been developed to reduce the associated radiation dose. The authors have embarked on a prospective phase II study to examine the feasibility and efficacy of low dose CT in men on surveillance for stage I germ cell tumors. The standard dose protocol included 5 mm thickness cuts reconstructed every 2.5 mm. The low dose protocol used similar cuts but reduced the minimum/maximum mA from 40/440 to 20/220. Standard deviation of noise was increased from 15 to 22.5 as well. No intravenous contrast medium was used in these patients. Three radiologists independently evaluated images for noise and diagnostic quality. Two of 3 readers found 1 examination out of 100 with low dose technique unacceptable. The authors conclude that many CT technical parameters can be adjusted to decrease the radiation dose. They believe that a lower dose multidetector CT protocol provided diagnostically acceptable studies in almost all patients. There are ongoing studies that will compare magnetic resonance imaging to CT, with the clear-cut advantage of magnetic resonance imaging being the absence of radiation whatsoever. Jerome P. Richie, M.D.
Bladder, Penis and Urethral Cancer, and Basic Principles of Oncology Carcinoma of the Urethra: Radiation Oncology B. F. Koontz and W. R. Lee Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina Urol Clin North Am 2010; 37: 459 – 466.
Urethral cancer is a rare but aggressive neoplasm. Early-stage distal lesions can be successfully treated with a single modality. Results for definitive radiotherapy using either or both external beam radiation therapy and brachytherapy have shown excellent cure rates in men and women. The primary advantage of radiotherapy is organ preservation. Advanced tumors, however, have poor outcomes with single modality treatment. Results have been improved using a combination of radiotherapy and chemotherapy, chiefly 5-fluorouracil and mitomycin C. Although literature is limited to case reports because of the rarity of the disease, the markedly improved results compared with older results of surgery with or without radiation warrant consideration.
1281
LAPAROSCOPY/NEW TECHNOLOGY
Laparoscopy/New Technology Use of a Novel Absorbable Barbed Plastic Surgical Suture Enables a “Self-Cinching” Technique of Vesicourethral Anastomosis During Robot-Assisted Prostatectomy and Improves Anastomotic Times A. K. Tewari, A. Srivastava, P. Sooriakumaran, A. Slevin, S. Grover, O. Waldman, S. Rajan, M. Herman, R. Berryhill, Jr. and R. Leung LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York J Endourol 2010; 24: 1645–1650.
Purpose: To demonstrate a novel technique of self-cinching anastomosis using a barbed and looped suture during robot-assisted radical prostatectomy (RARP). Patients and Methods: This is a feasibility study of 50 consecutive patients who underwent this novel self-cinching anastomotic technique using a V-Loc™ 180 absorbable barbed suture after RARP for clinically localized prostate cancer. The results were then compared with 50 consecutive patients who underwent RARP by the same surgeon before this new technique. We examined whether this novel technique had any effects on posterior reconstruction time, vesicourethral anastomosis time, and thus total reconstruction and operative time by inference. Results: The V-Loc 180 group had significantly shorter posterior reconstruction (40 seconds vs 60 seconds; p ⱕ0.001) and vesicourethral anastomotic times (7 min vs 12 min; p ⱕ0.001). By inference, this meant that total reconstruction and operative times were also significantly less (8 minutes vs 13.5 min; p ⱕ0.001 and 106 min vs 114.5 minutes; p ⱕ0.001, respectively). Conclusion: We have shown that this technique is feasible and improves posterior reconstruction and anastomotic times. Further follow-up will determine any benefits of this technique on anastomotic urinary leak rates, continence, and catheter removal times. Editorial Comment: Barbed sutures that obviate the need for an assistant to follow and hold tension manually on a running suture have been available for several years. Their applicability to urology had previously been limited by the availability of needle type and size, although with new smaller tapered needles and the increasing use of laparoscopic reconstructive procedures their advantage becomes obvious. Many urological surgeons, including myself, have been using these sutures routinely for robotic/laparoscopic vesicourethral anastomosis and partial nephrectomy renorrhaphy. The ease of maintaining tension and tissue approximation facilitate these complex tasks. Jeffrey A. Cadeddu, M.D.
Urological Oncology: Testis Cancer Comparison of Low Dose With Standard Dose Abdominal/Pelvic Multidetector CT in Patients With Stage 1 Testicular Cancer Under Surveillance M. E. O’Malley, P. Chung, M. Haider, H. J. Jang, K. Jhaveri, K. Khalili, T. Panzarella and P. Warde Joint Department of Medical Imaging, Princess Margaret Hospital, Toronto, Ontario, Canada Eur Radiol 2010; 20: 1624 –1630.
Purpose: To compare the image quality and acceptability of a low dose with those of standard dose abdominal/pelvic multidetector CT in patients with stage 1 testicular cancer managed by surveillance.
BLADDER, PENIS AND URETHRAL CANCER, AND BASIC PRINCIPLES OF ONCOLOGY
Methods: One hundred patients (median age 31 years; range 19 – 83 years), 79 with seminoma and 21 with non-seminoma, underwent abdominal/pelvic imaging with low and standard dose protocols on 64-slice multidetector CT. Three reviewers independently evaluated images for noise and diagnostic quality on a 5-point scale and for diagnostic acceptability. Results: On average, each reader scored noise and diagnostic quality of standard dose images significantly better than corresponding low dose images (p ⬍0.0001). One reader found all CT examinations acceptable; two readers each found 1/100 (1%) low dose examinations unacceptable. Median and mean dose-length product for low and standard dose protocols were 416.0 and 452.2 (range 122.9 –913.4) and 931.9 and 999.8 (range 283.8 – 1,987.7) mGy cm, respectively. Conclusions: The low dose protocol provided diagnostically acceptable images for at least 99% of patients and achieved mean dose reduction of 55% compared with the standard dose protocol. Editorial Comment: As surveillance has become more commonplace for patients with low stage nonseminomatous testis tumors and most patients with seminoma, increased interest has been focused on the effects of computerized tomography. With heightened awareness regarding the potential risks of low level ionizing radiation from CT, low dose CT protocols have been developed to reduce the associated radiation dose. The authors have embarked on a prospective phase II study to examine the feasibility and efficacy of low dose CT in men on surveillance for stage I germ cell tumors. The standard dose protocol included 5 mm thickness cuts reconstructed every 2.5 mm. The low dose protocol used similar cuts but reduced the minimum/maximum mA from 40/440 to 20/220. Standard deviation of noise was increased from 15 to 22.5 as well. No intravenous contrast medium was used in these patients. Three radiologists independently evaluated images for noise and diagnostic quality. Two of 3 readers found 1 examination out of 100 with low dose technique unacceptable. The authors conclude that many CT technical parameters can be adjusted to decrease the radiation dose. They believe that a lower dose multidetector CT protocol provided diagnostically acceptable studies in almost all patients. There are ongoing studies that will compare magnetic resonance imaging to CT, with the clear-cut advantage of magnetic resonance imaging being the absence of radiation whatsoever. Jerome P. Richie, M.D.
Bladder, Penis and Urethral Cancer, and Basic Principles of Oncology Carcinoma of the Urethra: Radiation Oncology B. F. Koontz and W. R. Lee Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina Urol Clin North Am 2010; 37: 459 – 466.
Urethral cancer is a rare but aggressive neoplasm. Early-stage distal lesions can be successfully treated with a single modality. Results for definitive radiotherapy using either or both external beam radiation therapy and brachytherapy have shown excellent cure rates in men and women. The primary advantage of radiotherapy is organ preservation. Advanced tumors, however, have poor outcomes with single modality treatment. Results have been improved using a combination of radiotherapy and chemotherapy, chiefly 5-fluorouracil and mitomycin C. Although literature is limited to case reports because of the rarity of the disease, the markedly improved results compared with older results of surgery with or without radiation warrant consideration.
1281