ABSTRACT: Intraoperative Frozen Section (IFS) with further tissue resection in case of positive margins has been proposed to decrease positive surgical margins rate during radical prostatectomy. There are a few reports on the benefits of this potential reduction of positive margins (PSM).
The aim of this study is to assess the oncological advantages of PSM rate reduction with the use of IFS and additional tissue excision in case of PSM. DESIGN, SETTING AND PARTECIPANTS: 270 patients undergoing laparoscopic radical prostatectomy were included in a prospective study, to evaluate the results of further tissue excision in case of PSM at IFS. Median age was 65 yrs. Median PSA was 7.0 ng/ml.
The prostate was extracted during the operation. IFS was performed in all patients on the prostate surface, at the base, the apex and along the postero-lateral aspect of the gland. In case of PSM additional tissue was excised from the site of the prostatic bed corresponding to the surgical margin.
Endpoint was biochemical recurrence-free survival.
PSM were found in 67 patients (24.8%). With additional tissue resection, PSM rate dropped from 24.8% to 12.6%. Decreased PSM after further resection didn't improve biochemical-free survival. Patients with initial PSM at IFS rendered negative with further resection, had similar results if compared to patients with margins still positive, and worse results if compared to patients with negative margins (NSM). Biochemical recurrence rate was 2.95% at 58 months in 203 patients with NSM, 15.1% at 54 months in 33 patients with PSM at IFS that were rendered negative after further resection, and 11.7% at 67 months in 34 patients with still PSM after additional resection. These results were confirmed also according to: stage, nerve-sparing procedure, Gleason score.
Our data don't support IFS during radical prostatectomy to improve biochemical-free survival.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 12/2010; 82(4):164-9.
ABSTRACT: To introduce a new and easy technique to perform laparoscopic vesicourethral anastomosis with a single-suture, single-knot, running procedure.
We have performed 350 laparoscopic radical prostatectomies. In a prospective study, we evaluated a new anastomosis technique in 50 consecutive cases. A multiple knot is prepared at 4 cm from the end of a suture. Then the running suture is started at the bladder neck at 4 o'clock. The posterior plate is maintained open for the first throws, and the suture is pulled only after the third passage at the bladder neck. Then the running suture is completed clockwise and finally tied to the 4-cm tail.
Use of this technique in 50 patients was compared with use of a double running suture in 50 other patients. The 2 groups were comparable. The new procedure was related to a decreased anastomotic time, without complications, with no leak at catheter removal at postoperative day 5 or 6.
The experience with this original anastomosis is still preliminary, but the results are very promising, and we would like to propose it to laparoscopic urologists.
Urology 10/2008; 72(6):1341-3. · 2.43 Impact Factor
ABSTRACT: The prostate cancer detection rate in patients with elevated prostate specific antigen (PSA) increases with extended needle biopsy protocols. Transperineal biopsy under transrectal ultrasound guidance is rarely reported, although notable cancer diagnoses are obtained with this technique. We describe the results of 6 and 12 core transperineal biopsy.
A total of 214 patients with PSA greater than 4.0 ng/ml were prospectively randomized to undergo 6 or 12 core transperineal biopsy. Each group of 107 patients was comparable in terms of clinical characteristics. The procedure was performed on an outpatient basis using local anesthesia. Specimens were obtained with a fan technique with 2 puncture sites slightly above the rectum (1 per lobe) under transrectal ultrasound guidance. Cores were taken from all peripheral areas, including the far lateral aspect of the prostate.
The overall cancer detection rate was 38% and 51% for 6 and 12 core biopsy, respectively. In patients with PSA between 4.1 and 10 ng/ml the cancer detection rate was 30% and 49% for 6 and 12 core biopsy, respectively.
The 12 core transperineal prostate biopsy is superior to 6 core biopsy. The technique provides optimal prostate cancer diagnosis. About half of the patients with PSA greater than 4.0 ng/ml and a slightly lower percent with PSA between 4.1 and 10 ng/ml have prostate cancer.
The Journal of Urology 02/2004; 171(1):197-9. · 3.75 Impact Factor