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Find video protocols related to scientific articles indexed in Pubmed.
A Comparative Analysis of Complications After Robot-Assisted Radical Prostatectomy for Men Aged ?69 and ?70 Years.
J. Endourol.
PUBLISHED: 09-12-2014
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Abstract Background and Purpose: Robot-assisted radical prostatectomy (RARP) is a popular treatment option for localized prostate cancer. Literature is lacking on the effect of advanced age on complication rates in men undergoing robotic prostatectomy. We performed a comparative analysis of complication rates for men ?69 and ?70 years undergoing RARP. Methods: After IRB approval, we reviewed our initial 1000 consecutive patients who underwent RARP from 6/2002 to 6/2011 for intraoperative and postoperative complications, and we compared complication rates stratified by age ?69 and ?70 years. Complications were graded according to the Clavien-Dindo classification system. The Fischer's exact test was used to compare complication rates, and a p-value of <0.05 was considered statistically significant. Results: In our cohort, 868 men were ?69 and 129 men were ?70. Overall, the intraoperative and postoperative complication rates for the entire cohort were 0.90% and 10.2%, respectively. There was no statistically significant difference in individual postoperative complications between the two groups, however, the overall postoperative complications rates for men ?69 and ?70 were 9.4% and 15.4%, respectively (p-value=0.043). Major complication rates for men ?69 and ?70 were 6.7% (58) and 10.8% (14), respectively (p=0.10); minor complications rates were 2.8% (22) and 4.6% (6), respectively (p=0.25). Conclusions: In our study, men ?70 had a significantly higher overall complication rate after RARP compared with men ?69 years; however, the individual, minor, and major complications were not different between the two groups. RARP is relatively safe in this older age group. Identifying complications and proposing insightful working solutions have decreased both minor and major complication rates after RARP.
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Long-term outcomes in severe lower urinary tract symptoms in men undergoing robotic-assisted radical prostatectomy.
Urology
PUBLISHED: 08-05-2014
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To address a major concern driving treatment intervention, we studied incontinence and urinary quality of life (QOL) before and after robotic-assisted radical prostatectomy (RARP). In men with severe lower urinary tract symptoms (LUTS), this is the first observational study analyzing short- and long-term urinary outcomes of RARP.
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A Comparative Analysis of Complications After Robotic-Assisted Radical Prostatectomy for Men Aged ?69 and ?70 Years.
J. Endourol.
PUBLISHED: 08-02-2014
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Background and Purpose: Robotic assisted radical prostatectomy (RARP) is a popular treatment option for localized prostate cancer. Literature is lacking on the effect of advanced age on complication rates in men undergoing robotic prostatectomy. We performed a comparative analysis of complication rates for men ? 69 and ?70 years undergoing RARP. Methods: After IRB approval, we reviewed our initial 1000 consecutive patients who underwent RARP from 6/2002 to 6/2011 for intraoperative and postoperative complications, and we compared complication rates stratified by age ?69 and ?70 years. Complications were graded according to the Clavien-Dindo classification system. The Fischer's exact test was used to compare complication rates and a p- value of <0.05 was considered statistically significant. Results: In our cohort, 868 men were ?69 and 129 men were ?70. Overall, the intraoperative and postoperative complication rates for the entire cohort were 0.90% and 10.2%, respectively. There was no statistically significant difference in individual postoperative complications between the two groups, however, the overall postoperative complications rates for men ?69 and ?70 was 9.4% and 15.4%, respectively (p-value=0.043). Major complication rates for men ?69 and ?70 were 6.7% (58) and 10.8% (14), respectively (p=0.10); minor complications rates, 2.8% (22) and 4.6% (6), respectively (p=0.25). Conclusions: In our study, men ?70 had a significantly higher overall complication rate after RARP compared to men ?69 years; however the individual, minor, and major complications were not different between the two groups. RARP is relatively safe in this older age group. Identifying complications and proposing insightful working solutions has decreased both minor and major complication rates after RARP.
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Phase 1 clinical trial of Vesicare™ (solifenacin) in the treatment of urinary incontinence after radical prostatectomy.
J. Endourol.
PUBLISHED: 07-21-2014
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Permanent and prolonged incontinence following robot assisted radical prostatectomy (RARP) is known to result from injury to the external sphincter. We hypothesize that pre-existing detrusor overactivity may also contribute to delayed return of continence (>3 months). This pilot study examines the safety profile and efficacy of muscarinic receptor antagonist, solifenacin, in incontinent men after prostatectomy.
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Urinary nerve growth factor as an oncologic biomarker for prostate cancer aggressiveness.
Urol. Oncol.
PUBLISHED: 01-20-2014
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We investigated urinary nerve growth factor (NGF) as a novel urinary biomarker for high-grade prostate cancer (PCa).
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Generation of "virtual" control groups for single arm prostate cancer adjuvant trials.
PLoS ONE
PUBLISHED: 01-01-2014
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It is difficult to construct a control group for trials of adjuvant therapy (Rx) of prostate cancer after radical prostatectomy (RP) due to ethical issues and patient acceptance. We utilized 8 curve-fitting models to estimate the time to 60%, 65%, … 95% chance of progression free survival (PFS) based on the data derived from Kattan post-RP nomogram. The 8 models were systematically applied to a training set of 153 post-RP cases without adjuvant Rx to develop 8 subsets of cases (reference case sets) whose observed PFS times were most accurately predicted by each model. To prepare a virtual control group for a single-arm adjuvant Rx trial, we first select the optimal model for the trial cases based on the minimum weighted Euclidean distance between the trial case set and the reference case set in terms of clinical features, and then compare the virtual PFS times calculated by the optimum model with the observed PFSs of the trial cases by the logrank test. The method was validated using an independent dataset of 155 post-RP patients without adjuvant Rx. We then applied the method to patients on a Phase II trial of adjuvant chemo-hormonal Rx post RP, which indicated that the adjuvant Rx is highly effective in prolonging PFS after RP in patients at high risk for prostate cancer recurrence. The method can accurately generate control groups for single-arm, post-RP adjuvant Rx trials for prostate cancer, facilitating development of new therapeutic strategies.
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Preserving continence during robotic prostatectomy.
Curr Urol Rep
PUBLISHED: 06-15-2013
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Preservation of postoperative urinary continence remains the primary concern of all men and their surgeons following robot-assisted radical prostatectomy (RARP). Without doubt, continence is the most important quality of life issue following radical prostatectomy. Identification of difficulties and lessons learned over time has helped focus efforts in order to improve urinary quality of life and continence. This review will examine definitions of continence and urinary quality of life evaluation, technical aspects and the impact of patient-related factors affecting time to and overall continence.
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Detailed analysis of patients with metastasis to the prostatic anterior fat pad lymph nodes: a multi-institutional study.
J. Urol.
PUBLISHED: 02-15-2013
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Lymph nodes in the prostatic anterior fat pad rarely harbor metastatic disease. Therefore, the characteristics of patients with prostatic anterior fat pad lymph node metastasis are not well described in the literature. We identified the perioperative characteristics and assessed the clinical outcomes of patients with prostatic anterior fat pad lymph node metastasis.
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Preventing perioperative complications of robotic-assisted radical prostatectomy.
Urology
PUBLISHED: 02-05-2013
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To report the change in complication rates after the identification and modification of technique to reduce their incidence during robot-assisted radical prostatectomy (RARP).
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Robotic-assisted radical prostatectomy after the first decade: surgical evolution or new paradigm.
ISRN Urol
PUBLISHED: 01-01-2013
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Early studies indicate that robotic-assisted radical prostatectomy (RARP) has promising short-term outcomes; however, RARP is beyond its infancy, and the long-term report cards are now beginning. The important paradigm shift introduced by RARP is the reevaluation of the entire open radical prostatectomy experience in surgical technique by minimizing blood loss and complications, maximizing cancer free outcomes, and a renewed assault in preserving quality of life outcomes by many novel mechanisms. RARP provides a new technical "canvas" for surgical masters to create upon, and in ten years, has reinvigorated a 100-year-old "gold standard" surgery.
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Athermal tension adjustable suture ligation of the vascular pedicle during robot-assisted prostatectomy.
J. Endourol.
PUBLISHED: 12-22-2011
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We report a simple figure-of-eight tension adjustable suture to ligate the vascular pedicle (VP) during robot-assisted radical prostatectomy (RARP).
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Simple method to predict return of continence after robot-assisted radical prostatectomy.
J. Endourol.
PUBLISHED: 08-04-2011
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After removal of the Foley catheter after robot-assisted radical prostatectomy (RARP), recovery of continence can take days to months. We sought to identify a simple means to predict time to recovery of postoperative continence.
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The impact of cavernosal nerve preservation on continence after robotic radical prostatectomy.
BJU Int.
PUBLISHED: 01-18-2011
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• To evaluate associations between baseline characteristics, nerve-sparing (NS) status and return of continence, as a relationship may exist between return to continence and preservation of the neurovascular bundles for potency during radical prostatectomy (RP).
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Transverse versus vertical camera port incision in robotic radical prostatectomy: effect on incisional hernias and cosmesis.
Urology
PUBLISHED: 01-02-2011
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To examine the incidence of incisional hernias (IHs) and propose a simple modification to reduce the incidence of IHs. Robot-assisted radical prostatectomy (RARP) historically uses a vertical midline camera port incision to extract the prostate.
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Impact of regional hypothermia on urinary continence and potency after robot-assisted radical prostatectomy.
J. Endourol.
PUBLISHED: 07-14-2010
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This is the third publication that updates clinical outcomes using a novel technique to apply locoregional hypothermia to the pelvis during robot-assisted radical prostatectomy (RARP) to reduce inflammatory injury. This report updates urinary and sexual clinical outcomes with a minimum of 1 year follow-up.
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Continence definition after radical prostatectomy using urinary quality of life: evaluation of patient reported validated questionnaires.
J. Urol.
PUBLISHED: 02-20-2010
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After radical prostatectomy continence is commonly defined as no pads except a security pad or 0 to 1 pad. We evaluated the association of pad status and urinary quality of life to determine whether security and 1 pad status differ from pad-free status to better define 0 pads as the post-prostatectomy standard.
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Sacrifice of accessory pudendal arteries in normally potent men during robot-assisted radical prostatectomy does not impact potency.
J Sex Med
PUBLISHED: 11-13-2009
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Whether or not sacrificing accessory pudendal arteries (APAs) during radical prostatectomy affects potency has been an ongoing source of concern. Herein, we present our potency results relative to sacrificing APAs in normally pre-potent men following robot-assisted radical prostatectomy (RARP).
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Hypothermic robotic radical prostatectomy: impact on continence.
J. Endourol.
PUBLISHED: 08-25-2009
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Radical prostatectomy undoubtedly causes inflammatory damage to surrounding neuromuscular tissues (i.e., bladder, urethra, and nerves) that may contribute to urinary incontinence. We report the use of local hypothermia during robot-assisted laparoscopic prostatectomy to attenuate this injury.
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Robot-assisted radical prostatectomy: current evaluation of surgical margins in clinically low-, intermediate-, and high-risk prostate cancer.
J. Endourol.
PUBLISHED: 07-22-2009
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Concern exists over a lack of tactile sensation and positive surgical margins (PSMs) in patients undergoing robot-assisted radical prostatectomy. We report our PSM rates in our most current 500 cases and particularly in clinically high-risk disease.
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Preliminary study of virtual reality and model simulation for learning laparoscopic suturing skills.
J. Urol.
PUBLISHED: 07-18-2009
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Repetitive practice of laparoscopic suturing and knot tying can facilitate surgeon proficiency in performing this reconstructive technique. We compared a silicone model and pelvic trainer to a virtual reality simulator in the learning of laparoscopic suturing and knot tying by laparoscopically naïve medical students, and evaluated the subsequent performance of porcine laparoscopic cystorrhaphy.
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Quantitative and qualitative analysis of the recovery of potency after radical prostatectomy: effect of unilateral vs bilateral nerve sparing.
BJU Int.
PUBLISHED: 04-17-2009
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To analyse the impact of a approximately 50% reduction of cavernous nervous tissue on the qualitative and quantitative recovery of sexual function after unilateral (UNS) and bilateral (BNS) nerve-sparing robotic radical prostatectomy (RALP), by evaluating these differences in two groups treated with cautery and a cautery-free technique (CFT).
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Hypothermic nerve-sparing radical prostatectomy: rationale, feasibility, and effect on early continence.
Urology
PUBLISHED: 02-28-2009
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To report the first application of preemptive local hypothermia during robotic-assisted laparoscopic prostatectomy (hRLP) to attenuate inflammation. Surgical excision of the prostate during radical prostatectomy causes inflammatory damage to the surrounding neuromuscular tissues that could affect urinary continence.
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Single institution 2-year patient reported validated sexual function outcomes after nerve sparing robot assisted radical prostatectomy.
J. Urol.
PUBLISHED: 01-28-2009
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To identify surgeon specific factors for preserving sexual function (and minimize patient related factors) we report 2-year potency outcomes in men 65 years or younger with normal preoperative sexual function undergoing nerve sparing robot assisted laparoscopic radical prostatectomy.
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Annexin A2 positively contributes to the malignant phenotype and secretion of IL-6 in DU145 prostate cancer cells.
Int. J. Cancer
PUBLISHED: 01-08-2009
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Several groups, including ours, have reported that annexin A2 (ANXA2) expression is reduced in most prostate cancer (CaP). More recently, however, we reported that ANXA2 is expressed in some high-grade tumors, but the biologic consequence of this is currently unknown. To elucidate the function of ANXA2 in CaP, we reduced its expression in DU145 cells using shRNA and tested the impact on characteristics of malignancy. Reduction of ANXA2 suppressed anchorage-dependent and -independent cell growth without affecting invasiveness. Interestingly, interleukin-6 (IL-6) secretion was reduced concomitantly with the reduction of ANXA2 but independently of S100A10. IL-6 expression was restored when wild type but not mutant ANXA2 was reexpressed in these cells. In a retrospective study of radical prostatectomy specimens from patients with nonmetastatic CaP, 100% of patients with ANXA2-positive tumors (n = 4) had a biochemical relapse while only 50% of patients with ANXA2 negative tumors (n = 20) relapsed, suggesting that ANXA2 expression in prostate tumors may be predictive of biochemical relapse. Significant cytoplasmic staining of ANXA2 was detected in 3 of 4 ANXA2-positive tumors, whereas ANXA2 is localized to the plasma membrane in benign prostatic glands. These finding, taken together, suggests a possible mechanism whereby ANXA2 expression positively contributes to an aggressive phenotype in a subset of CaP and suggest that ANXA2 has markedly different functions depending on its cellular context. Finally, this is the first description of a role for ANXA2 in IL-6 expression, and ANXA2 represents a new therapeutic target for reducing IL-6 in high-grade prostate cancer.
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The application of regional hypothermia using transrectal cooling during radical prostatectomy: mitigation of surgical inflammatory damage to preserve continence.
J. Endourol.
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Preservation of continence and sexual function continues to be a formidable quality-of-life issue regarding outcomes after radical prostatectomy. There is little argument that physical preservation of the nerves and sphincters is a critical component to achieving success in these domains. Previously demonstrated factors such as advancing age, deteriorating physical health status, and subnormal baseline potency negatively impact outcomes. Our hypothesis, however, has been that inflammatory response to surgery has a large impact on surgical outcomes of prostatectomy. Trauma-induced inflammation could account for variation in recovery despite nearly identical surgery on many patients, especially in high-volume surgeons. In other words, we suggest and maintain that younger and healthier patients tolerate and/or recover better from the trauma/inflammation of surgery. Those who do not recover as well may have altered inflammatory response to injury. A common response to decrease inflammation in response to physical injury would be as simple as to cool the injury with ice. Previous neurologic studies have suggested that using ice during surgical intervention can reduce the inflammatory damage. Therefore, we applied this concept that preemptive hypothermia could reduce inflammation to the robot-assisted prostatectomy procedure to potentially lead to improved continence and potency outcomes. In 2009, we introduced the concept of regional hypothermia via an endorectal cooling balloon during robot-assisted radical prostatectomy (RARP). We have published our single institution data demonstrating a significant reduction of overall incontinence. Defining continence as zero-pads, our overall 1-year incontinence has been reduced by 70% (from 13% to 4%). Severe incontinence, defined as two or more pads, was likewise reduced by 70% (from 2.9% to 0.9%). Regional hypothermia used during the time of surgery represents a novel strategy for minimizing inflammation and subsequent muscle and nerve damage in RARP.
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Robot-assisted radical prostatectomy: 5-year oncological and biochemical outcomes.
J. Urol.
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We investigated oncological outcomes in patients who underwent robot-assisted radical prostatectomy more than 5 years previously.
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