Adley Raboy

Early experience with extraperitoneal endoscopic radical retropubic prostatectomy

Abstract. This article reports our early experience using laparoscopic instruments and techniques when performing radical retropubic prostatectomy through an entirely extraperitoneal endoscopic approach. Two patients with localized adenocarcinoma of the prostate underwent endoscopic radical retropubic prostatectomy through an entirely extraperitoneal approach (EERRP). The procedure was evaluated for its efficacy in removing prostate and seminal vesicles and in effecting complete vesicourethral anastomosis. Operative time, blood loss, hospital stay, and pathology were also evaluated. Complete endoscopic removal of the prostate and seminal vesicles was achieved in both patients. Endoscopic reconstruction of the bladder neck with watertight anastamosis was successful in both. Operative time and estimated blood loss improved from 5 h and 45 min and 600 cc, respectively, in patient 1 to 4 h and 400 cc in patient 2. Hospital stay was 2.5 days for both. The early experience for EERRP is encouraging. Further evaluation to standardize technique and determine its efficacy and role in treating prostate cancer is in order.

Extraperitoneal endoscopic pelvic lymph node dissection (EEPLND)

Extraperitoneal endoscopic pelvic lymph node dissection was performed in 60 patients for staging of organ-confined prostatic carcinoma. This procedure has significant advantages over the node dissection performed laparoscopically and should be adopted as the operative approach for staging of prostatic carcinoma.

Argon laser-assisted vasovasostomy

Laser-assisted vasovasostomy recently has become a popular procedure in the United States. Only the microsurgical carbon dioxide laser is approved by the Food and Drug Administration for vasovasostomies. Using the HGM argon laser, the procedure was performed on 3 laboratory dogs with a patency rate of 100 percent (6/6) and anastomotic leak 17 percent (1/6). This procedure requires little microsurgical expertise, can be performed without the use of a microscope, and does not require a perfectly dry field. The argon laser is a superior technique to previously described laser-assisted vasovasostomies and further clinical correlation is recommended.

HIGH DOSE COMBINATION RADIOTHERAPY FOR THE TREATMENT OF LOCALIZED PROSTATE CANCER: REPLY BY AUTHORS

PURPOSE We evaluate the efficacy of high dose combination radiotherapy for the treatment of localized prostate cancer. MATERIALS AND METHODS A total of 212 patients with localized prostate cancer (T1-T3) were treated with transperineal radioactive seed implantation followed by 45 Gy. external beam radiation therapy. Patients with Gleason scores of 2-5 were treated with 125iodine at a minimum peripheral dose of 120 Gy., while 103palladium at a minimum peripheral dose of 90 Gy. was used for those with Gleason scores of 7-10. Patients with Gleason 6 diploid tumors were treated with 125iodine and those with aneuploid tumors were treated with 103palladium. Biochemical failure was defined as inability to achieve a prostate specific antigen nadir value of 0.5 ng./ml. or less. No patient was treated with androgen deprivation therapy. RESULTS The 212 patients have a minimum of 24 months of followup (mean 33 months). Prostate specific antigen 0.5 ng./ml. or less was reached by 72% of the patients (152 of 212) and positive biopsies were detected in 13.9% (20 of 144). Using life table survivorship analysis the probability of initial biochemical success at 5 years was 91% (95% confidence interval, 83 to 97). The probability of subsequent failure following an initial success was 11% (95% confidence interval, 6 to 20) at 24 months. The complications of combination therapy included proctitis in 21.4% (47 of 212 men), impotence in 38% (38 of 100), urinary retention in 1.5%, incontinence in 2.8%, rectoprostate fistula in 2.4%, rectal wall breakdown in 0.5% and urethral stricture in 0.5%. Six patients (2.8%) required colostomy and urinary diversion. CONCLUSIONS Short-term responses to high dose combination radiotherapy for localized prostate cancer are promising. The morbidity is acceptable. Further long-term followup is warranted to assess this treatment.