Urethral-sparing Robot-assisted Simple Prostatectomy: An Innovative Technique to Preserve Ejaculatory Function Overcoming the Limitation of the Standard Millin Approach.

Abstract:

BACKGROUND:Despite recent technical innovations in the treatment of benign prostatic hyperplasia (BPH), retrograde ejaculation is still one of the most frequent adverse effects, with a major impact on patients' quality of life. OBJECTIVE:To evaluate the efficacy of our technique of urethral-sparing robotic-assisted simple prostatectomy (usRASP) in obtaining effective deobstruction and maintaining anterograde ejaculation, and secondarily, to compare these outcomes with those of a control group of patients who underwent standard robotic adenomectomy according to the Millin technique. DESIGN, SETTING, AND PARTICIPANTS:We prospectively enrolled patients between August 2017 and July 2019 with large BPH (prostate volume >80 ml) affected by significant BPH-related lower urinary tract symptoms (LUTS) who underwent usRASP. Then, a retrospective control group treated with standard Millin robotic-assisted simple prostatectomy (RASP) was selected. SURGICAL PROCEDURE:The innovative aspect of our technique is the pivotal role of enucleation of the adenoma from all the anatomical structures, especially from the urethra. On the basis of the final results, the patients were divided into three groups (full, partial, or failed urethral sparing). Control group patients underwent standard Millin. MEASUREMENTS:All perioperative and follow-up data were collected, and descriptive, univariate, and multivariate analyses were performed. RESULTS AND LIMITATIONS:Ninety-two patients were enrolled. Full urethral-sparing adenomectomy was performed in 56 cases (60.86%). Urethral-sparing adenomectomy with minimal urethral infraction occurred in 21 cases (22.82%). In 15 patients (16.48%), the procedure was converted to standard RASP. Clavien grade ≥3 complications occurred in two patients (2%). Among the 70 patients with preoperative ejaculation, 57 (81%) maintained anterograde ejaculation at the 12th postoperative month. The maximum flow rate increased (17 m/s from baseline, p =  0.034), and International Prostate Symptom Score decreased rapidly (from 20 to 5 points; p <  0.001). With respect to the technique of the control group patients, usRASP allows the same perioperative and urinary functional outcomes, but with an improvement in terms of sexual function, especially for the ejaculation (p <  0.001 at every time point). A small sample size and short follow-up time are the major limitations of this study. CONCLUSIONS:Urethral-sparing RASP has been found to be a safe and effective procedure that allows resolution of LUTS in large BPH and maintaining of ejaculatory function in a high percentage of patients. PATIENT SUMMARY:Based on our findings, this technique should be considered as an option when counseling patients with large benign prostatic hyperplasia who are motivated to preserve antegrade ejaculation.

journal_name

Eur Urol

journal_title

European urology

authors

Porpiglia F,Checcucci E,Amparore D,Niculescu G,Volpi G,Piramide F,De Cillis S,Manfredi M,Autorino R,Fiori C

doi

10.1016/j.eururo.2020.09.028

subject

Has Abstract

pub_date

2020-10-05 00:00:00

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(20)30720-X

pub_type

杂志文章
  • Screening for prostate cancer.

    abstract::Early-stage prostate cancer is usually asymptomatic and therefore, in the past, has often gone undetected, unless diagnosed by a digital rectal examination. More recently, new tests have been introduced, namely prostate-specific antigen and transrectal ultrasound, in order to improve the detection of early-stage disea...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000474379

    authors: Chodak GW

    更新日期:1993-01-01 00:00:00

  • Preferential preservation of bone mineralisation by LHRH agonists in the treatment of metastatic prostate cancer.

    abstract::Histomorphometric measurements of tumour-free bone have been undertaken in a closely matched group of patients with metastatic prostate cancer treated either by subcapsular orchidectomy (SCO) or luteinising hormone-releasing hormone (LHRH) agonists. Age, fasting morning urine hydroxyproline/creatinine ratios, alkaline...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000473597

    authors: Clarke NW,McClure J,George NJ

    更新日期:1991-01-01 00:00:00

  • Iodine-125-seed implantation combined with external radiotherapy under potentially curative intention in patients with advanced stage-C prostatic cancer.

    abstract::We report on 18 patients, aged 43-77 years, with clinical stage-C adenocarcinoma of the prostate, primarily treated by pelvic lymphadenectomy and 125I-seed implantation. After lymphadenectomy, the staging assessment differed from the preoperative diagnosis as follows: 4 patients were classified as stage C; 6 as D1, an...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000472587

    authors: Frick J,Scrinzi U,Kunit G,Kogelnik HD

    更新日期:1986-01-01 00:00:00

  • Perioperative betamethasone treatment reduces signs of bladder dysfunction in a rat model for neurapraxia in female urogenital surgery.

    abstract:BACKGROUND:Information on autonomic neurapraxia in female urogenital surgery is scarce, and a model to study it is not available. OBJECTIVE:To develop a model to study the impact of autonomic neurapraxia on bladder function in female rats, as well as to assess the effects of corticosteroid therapy on the recovery of b...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2012.04.037

    authors: Castiglione F,Bergamini A,Bettiga A,Bivalacqua TJ,Benigni F,Strittmatter F,Gandaglia G,Rigatti P,Montorsi F,Hedlund P

    更新日期:2012-12-01 00:00:00

  • The relationships among filling, voiding subscores from International Prostate Symptom Score and quality of life in Japanese elderly men and women.

    abstract:OBJECTIVES:Lower urinary tract symptoms (LUTS) are reported to influence the quality of life (QoL) of the elderly. The aim of this study was to elucidate the relationships among filling problems, voiding problems and QoL in elderly men and women. METHODS:A total of 450 males and 228 females, aged 50 years or older res...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/s0302-2838(02)00438-4

    authors: Okamura K,Usami T,Nagahama K,Maruyama S,Mizuta E

    更新日期:2002-11-01 00:00:00

  • Differential diagnosis of testicular mass by cytological examination of seminal fluid collected by ejaculation or prostatic massage.

    abstract::The cytological examination of the seminal fluid of 3 patients with painless testicular masses was performed using an ordinary conventional technique. Neoplastic cells appeared in the ejaculate or fluid from prostatic massage of all patients. The final pathologies were seminoma, choriocarcinoma and mixed teratocarcino...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000463907

    authors: Yu DS,Wang J,Chang SY,Ma CP

    更新日期:1990-01-01 00:00:00

  • Ureteroureterostomy in complete ureteral duplication.

    abstract::Homolateral pelvic ureteroureterostomies were performed in 25 patients presenting with complete duplication of the pyeloureteric tract. The procedure was performed in 16 cases of ureteroceles, in 7 cases of reflux in duplicated ureters, in 1 case of ectopic ureter and in 1 postoperative stenosis of one segment of a do...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000473152

    authors: Bracci U,Miano L,Laurenti C

    更新日期:1979-01-01 00:00:00

  • Stool Microbiome Profiling of Patients with Metastatic Renal Cell Carcinoma Receiving Anti-PD-1 Immune Checkpoint Inhibitors.

    abstract::Preclinical models and early clinical data suggest an interplay between the gut microbiome and response to immunotherapy in solid tumors including metastatic renal cell carcinoma (mRCC). We sought to characterize the stool microbiome of mRCC patients receiving a checkpoint inhibitor (CPI) and to assess treatment-relat...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2020.07.011

    authors: Salgia NJ,Bergerot PG,Maia MC,Dizman N,Hsu J,Gillece JD,Folkerts M,Reining L,Trent J,Highlander SK,Pal SK

    更新日期:2020-10-01 00:00:00

  • Advances and trends in hormonal therapy for advanced prostate cancer.

    abstract::Hormonal therapy represents first-line treatment for patients with advanced prostate cancer. Generally, surgical castration is viewed as the 'gold standard' but carries with it a psychological effect. Medical alternatives include LHRH analogues, antiandrogens, and oestrogens, though the last of these is associated wit...

    journal_title:European urology

    pub_type: 杂志文章,评审

    doi:10.1159/000475049

    authors: Debruyne FM,Dijkman GA

    更新日期:1995-01-01 00:00:00

  • Cardiovascular morbidity associated with gonadotropin releasing hormone agonists and an antagonist.

    abstract:BACKGROUND:Androgen deprivation therapy (ADT) is associated with increased cardiovascular morbidity. OBJECTIVE:To determine whether cardiovascular morbidity differs following initiation of gonadotropin-releasing hormone (GnRH) agonists compared with an antagonist. DESIGN, SETTING, AND PARTICIPANTS:Pooled data from si...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2013.10.032

    authors: Albertsen PC,Klotz L,Tombal B,Grady J,Olesen TK,Nilsson J

    更新日期:2014-03-01 00:00:00

  • Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma.

    abstract:CONTEXT:The outcome prediction for renal cell cancer (RCC) remains controversial, and although many parameters have been tested for prognostic significance, only a few have achieved widespread acceptance in clinical practice. The TNM staging system defines local extension of the primary tumour (T), involvement of regio...

    journal_title:European urology

    pub_type: 杂志文章,评审

    doi:10.1016/j.eururo.2009.06.036

    authors: Moch H,Artibani W,Delahunt B,Ficarra V,Knuechel R,Montorsi F,Patard JJ,Stief CG,Sulser T,Wild PJ

    更新日期:2009-10-01 00:00:00

  • Long-term intravesical adjuvant chemotherapy further reduces recurrence rate compared with short-term intravesical chemotherapy and short-term therapy with Bacillus Calmette-Guérin (BCG) in patients with non-muscle-invasive bladder carcinoma.

    abstract:OBJECTIVE:We present a randomised, parallel group, multicentre phase 4 trial comparing short- and long-term chemoprophylaxis with Mitomycin C (MMC) with short-term immunoprophylaxis with Bacillus Calmette-Guérin (BCG) after transurethral resection of the bladder for non-muscle-invasive bladder carcinoma. METHODS:Four ...

    journal_title:European urology

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.eururo.2007.02.063

    authors: Friedrich MG,Pichlmeier U,Schwaibold H,Conrad S,Huland H

    更新日期:2007-10-01 00:00:00

  • More Than 15 Years of Experience with Intradetrusor OnabotulinumtoxinA Injections for Treating Refractory Neurogenic Detrusor Overactivity: Lessons to Be Learned.

    abstract:BACKGROUND:Intradetrusor onabotulinumtoxinA (BoNT-ONA) injections have become a well-established therapy for refractory neurogenic detrusor overactivity (NDO). However, little is known about long-term outcome and patients' adherence to this treatment. OBJECTIVE:To assess long-term outcomes of intradetrusor BoNT-ONA in...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2016.03.052

    authors: Leitner L,Guggenbühl-Roy S,Knüpfer SC,Walter M,Schneider MP,Tornic J,Sammer U,Mehnert U,Kessler TM

    更新日期:2016-09-01 00:00:00

  • Next-generation RNA sequencing of archival formalin-fixed paraffin-embedded urothelial bladder cancer.

    abstract:UNLABELLED:Molecular profiling of individual cancers is key to personalised medicine. While sequencing technologies have required stringent sample collection and handling, recent technical advances offer sequencing from tissues collected in routine practice and tissues already stored in archives. In this paper, we esta...

    journal_title:European urology

    pub_type: 信件

    doi:10.1016/j.eururo.2014.07.045

    authors: Liu Y,Noon AP,Aguiar Cabeza E,Shen J,Kuk C,Ilczynski C,Ni R,Sukhu B,Chan K,Barbosa-Morais NL,Hermanns T,Blencowe BJ,Azad A,van der Kwast TH,Catto JW,Zlotta AR,Wrana JL

    更新日期:2014-12-01 00:00:00

  • Crossed chemoprophylaxis assay between adriamycin and cis-platinum in recurrent superficial bladder tumor.

    abstract::Of 146 patients with superficial bladder carcinoma, 66 (35 primary and 31 recurrent from failure of thiotepa chemoprophylaxis) relapsed following transurethral resection (TUR) and chemotherapy with adriamycin or cis-platinum. A new TUR was carried out. In case of progression in the number of tumors, size, stage or gra...

    journal_title:European urology

    pub_type: 临床试验,杂志文章

    doi:10.1159/000472630

    authors: Llopis B,Gallego J,Mompó JA,Boronat F,Alonso M,Moreno B,Jiménez JF

    更新日期:1986-01-01 00:00:00

  • Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy.

    abstract:OBJECTIVES:Urinary incontinence is one of the major drawbacks of radical retropubic prostatectomy (RRP). One of the possible reasons for this urinary incontinence is a postoperative deficiency of the rhabdosphincter (RS). It has been recently demonstrated that reconstruction of the posterior aspects of the RS allows a ...

    journal_title:European urology

    pub_type: 临床试验,杂志文章

    doi:10.1016/j.eururo.2006.10.014

    authors: Rocco B,Gregori A,Stener S,Santoro L,Bozzola A,Galli S,Knez R,Scieri F,Scaburri A,Gaboardi F

    更新日期:2007-04-01 00:00:00

  • Cycling and penile oxygen pressure: the type of saddle matters.

    abstract:OBJECTIVES:Temporary genital numbness is a common side effect of long-distance cycling; cases of impotence have even been reported. Recent reports have shown that perineal compression leads to a decrease in penile blood flow. Reduced oxygen tension leads to penile fibrosis, which works counterproductively to the achiev...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/s0302-2838(01)00028-8

    authors: Schwarzer U,Sommer F,Klotz T,Cremer C,Engelmann U

    更新日期:2002-02-01 00:00:00

  • Association of mast cells with microvessel density in renal cell carcinomas.

    abstract:BACKGROUND:Growth of solid tumors requires angiogenesis. Evidence indicates that mast cells (MCs) play an important role in tumor angiogenesis. The aim of this study was to investigate the possible effects of angiogenesis and the presence of MCs on the prognosis of renal cell carcinoma (RCC). METHODS:Seventy-one patie...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2005.12.040

    authors: Tuna B,Yorukoglu K,Unlu M,Mungan MU,Kirkali Z

    更新日期:2006-09-01 00:00:00

  • Radical pelvic surgery and radiation therapy in the management of localized carcinoma of the prostate.

    abstract::A total of 181 prostatic cancer patients under radiation monotherapy were tested for the therapeutic effect of pelvic lymphadenectomy (PLA). Sixty-seven belonging to the pN0 category formed a highly selective group and presented a 89% rate of 7-year survival. Localized radiation therapy with pelvic irradiation (81 pat...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000472936

    authors: Schubert J,Kelly LU,Wehnert J,Moravek P

    更新日期:1988-01-01 00:00:00

  • Manufacture and clinical employment of an antibiotic silicon-rubber catheter.

    abstract::In order to present or minimize the frequent occurrence of urinary infection and other complications following indwelling catheterization, we devised a drug-releasing silicon catheter. Attached to its tip is an appliance which has a honeycomb pattern with many spaces into which antibiotic particles are inserted. In ou...

    journal_title:European urology

    pub_type: 杂志文章

    doi:

    authors: Cheng HJ

    更新日期:1988-01-01 00:00:00

  • p53 immunoreactivity as prognostic marker for cancer-specific survival in prostate cancer.

    abstract:OBJECTIVES:The objective of this study was to evaluate the role of p53 immunoreactivity as a prognostic marker in prostate cancer. METHODS:The nuclear accumulation of the aberrant p53 protein was determined by immunohisto-chemistry on surgical specimens and related to stage, grade and cancer-specific survival in 186 p...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000474147

    authors: Stattin P,Bergh A,Karlberg L,Nordgren H,Damber JE

    更新日期:1996-01-01 00:00:00

  • Tamoxifen treatment in oligozoospermia.

    abstract::This study of the effects of long-term tamoxifen administration on semen analysis of oligospermic males confirms the potential therapeutic efficacy in normogonadotrophic oligospermia. 38 out of the 56 patients responded well to long-term treatment with 30 mg tamoxifen daily. According to the nomenclature of Eliasson, ...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1159/000473241

    authors: Bartsch G,Scheiber K

    更新日期:1981-01-01 00:00:00

  • Combined androgen blockade is the treatment of choice for patients with advanced prostate cancer: the argument for.

    abstract::Combined androgen blockade (CAB) is becoming standard treatment for patients with newly diagnosed advanced prostate cancer. This statement is based on the outcome and long-term evaluation of patients treated in prospective randomised trials. Particularly, patients with 'good' prognostic signs at the time of diagnosis ...

    journal_title:European urology

    pub_type: 杂志文章,评审

    doi:10.1159/000473836

    authors: Debruyne FM

    更新日期:1996-01-01 00:00:00

  • Does internal urethrotomy prevent urethral stricture after transurethral prostatectomy. Early and late results.

    abstract::In a randomized study of 200 consecutive patients undergoing transurethral prostatectomy (TURP), the combination of internal urethrotomy and TURP (the trial group) was compared with TURP alone (the control group) with regard to the development of urethral strictures postoperatively. Three months after resection, 14% i...

    journal_title:European urology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1159/000471587

    authors: Nielsen KK,Kjoergaard B,Kristensen ES,Jeppesen L,Krarup T

    更新日期:1989-01-01 00:00:00

  • Urothelial differentiation in vesicoureteric reflux and other urological disorders of childhood: a comparative study.

    abstract:OBJECTIVE:The strong familial basis of vesicoureteric reflux (VUR) is well recognised, however little progress has been made in identifying the causative genes. In this study we have investigated whether human vesicoureteric reflux (VUR) is associated with the aberrant expression of urothelial differentiation-associate...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2005.08.018

    authors: Garthwaite MA,Thomas DF,Subramaniam R,Stahlschmidt J,Eardley I,Southgate J

    更新日期:2006-01-01 00:00:00

  • Recoverability of erectile function in post-radical cystectomy patients: subjective and objective evaluations.

    abstract:BACKGROUND:Literature regarding both subjective and objective evaluations of erectile function following radical cystectomy is deficient. OBJECTIVE:To study the recoverability of erectile function in post-radical cystectomy patients on subjective and objective bases. DESIGN, SETTING, AND PARTICIPANTS:Between March 20...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2008.06.072

    authors: Hekal IA,El-Bahnasawy MS,Mosbah A,El-Assmy A,Shaaban A

    更新日期:2009-02-01 00:00:00

  • Treatment of varicocele: a prospective randomized comparison of laparoscopy versus antegrade sclerotherapy.

    abstract:OBJECTIVES:To compare the therapeutic success, the morbidity and the costs of antegrade sclerotherapy versus laparoscopic varicocelectomy. METHODS:Seventy-six consecutive varicocele patients were randomly assigned to two treatment arms. Preoperative and 3 month postoperative sperm density, motility and morphology were...

    journal_title:European urology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s0302-2838(02)00022-2

    authors: Sautter T,Sulser T,Suter S,Gretener H,Hauri D

    更新日期:2002-04-01 00:00:00

  • Potential impact of postoperative early complications on the timing of adjuvant chemotherapy in patients undergoing radical cystectomy: a high-volume tertiary cancer center experience.

    abstract:BACKGROUND:Perioperative cisplatin combination chemotherapy is associated with a survival benefit in patients with invasive bladder cancer (BCa). However, in a recent report from the National Cancer Database (NCDB), only 11.6% of stage III BCa patients received perioperative chemotherapy, the majority in the adjuvant s...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2008.07.018

    authors: Donat SM,Shabsigh A,Savage C,Cronin AM,Bochner BH,Dalbagni G,Herr HW,Milowsky MI

    更新日期:2009-01-01 00:00:00

  • The role of radical prostatectomy and lymph node dissection in lymph node-positive prostate cancer: a systematic review of the literature.

    abstract:CONTEXT:Because pelvic lymph node (LN)-positive prostate cancer (PCa) is generally considered a regionally metastatic disease, surgery needs to be better defined. OBJECTIVE:To review the impact of radical prostatectomy (RP) and pelvic lymph node dissection (PLND), possibly in conjunction with a multimodal approach usi...

    journal_title:European urology

    pub_type: 杂志文章,评审

    doi:10.1016/j.eururo.2013.05.033

    authors: Gakis G,Boorjian SA,Briganti A,Joniau S,Karazanashvili G,Karnes RJ,Mattei A,Shariat SF,Stenzl A,Wirth M,Stief CG

    更新日期:2014-08-01 00:00:00

  • Clinical Efficacy of Injection and Mechanical Therapy for Peyronie's Disease: A Systematic Review of the Literature.

    abstract:CONTEXT:Conservative therapies for Peyronie's disease (PD) aim to treat early-stage disease by improving clinical outcomes such as penile curvature, penile length erectile dysfunction, and pain. OBJECTIVE:To summarise the available evidence regarding injection and mechanical therapies for PD treatment. EVIDENCE ACQUI...

    journal_title:European urology

    pub_type: 杂志文章

    doi:10.1016/j.eururo.2018.07.005

    authors: Russo GI,Milenkovic U,Hellstrom W,Levine LA,Ralph D,Albersen M

    更新日期:2018-12-01 00:00:00