Hartwig Schwaibold

Modular surgical training for endoscopic extraperitoneal radical prostatectomy

To develop a modular training scheme which enabled the use of individual steps of laparoscopic radical prostatectomy (RP) for teaching and training surgeons with varied experience, including residents with no experience in open RP, as in extending laparoscopic surgery to more complex operations like RP, the proper training of urologists is crucial.

Categorisation of complications of endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy

The aim of the present review is to focus on the various attempts of categorisation of complications after endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy. Several classifications of complications and adverse events have been proposed in the literature but none is widely accepted or applied so far. We thus present a review of the existing literature and the complications of our series of 900 patients treated with endoscopic extraperitoneal radical prostatectomy (EERPE). We applied the recently revised Clavien classification system to grade EERPE complications.

An Overview of the Diagnosis and Treatment of Erectile Dysfunction

Epidemiological studies have demonstrated an age-stratified increase in the incidence and prevalence of erectile dysfunction (ED). There is a greater degree of openness today when discussing sexual matters and more information on the treatment of ED is available to the public through the media. Quality-of-life issues are now a matter of great importance to the aging population. Men and their partners are no longer prepared to merely accept ED as a natural consequence of aging. The advent of a simple and effective oral therapy for ED has also indirectly fuelled the increase in treatment-seeking behaviour among men.Despite great strides in research into ED, our knowledge and understanding of the pathophysiological mechanisms is still in its infancy. As a result, we are able to treat only the symptom of ED rather than prevent it. Common diseases found in the population, such as diabetes mellitus and coronary artery disease appear to be risk factors for the development of ED. Therefore, physicians need to identify any underlying co-existing organic diseases in their patients presenting with ED.Whenever possible, patients are encouraged to attend their consultation sessions with their partners because ED is a condition affecting ‘the couple’ and not just the man. Psychogenic aspects of ED should also be explored during the consultation. Efforts need to be made to uncover and address the presence of any psychological stressors, if necessary with the help of a psychosexual therapist.The first-line treatment of ED is oral phosphodiesterase-5 inhibitors. For those who do not respond to oral therapy, there is no defined ‘step-ladder’ escalation in alternative therapy. It is up to the physician to discuss the options with the patient or couple and reach a decision based on their preference.

Technical solutions to improve the management of non‐muscle‐invasive transitional cell carcinoma: summary of a European Association of Urology Section for Uro‐Technology (ESUT) and Section for Uro‐Oncology (ESOU) expert meeting and current and future perspectives

The aim of the present review was to compare state‐of‐the‐art care and future perspectives for the detection and treatment of non‐muscle‐invasive transitional cell carcinoma (TCC) of the bladder. We provide a summary of the third expert meeting on ‘Optimising the management of non‐muscle‐invasive bladder cancer, organized by the European Association of Urology Section for Uro‐Technology (ESUT) in collaboration with the Section for Uro‐Oncology (ESOU), including a systematic literature review. The article includes a detailed discussion on the current and future perspectives for TCC, including photodynamic diagnosis, optical coherence tomography, narrow band imaging, the Storz Professional Image Enhancement system, magnification and high definition techniques. We also provide a detailed discussion of future surgical treatment options, including en bloc resection and tumour enucleation. Intensive research has been conducted to improve tumour detection and there are promising future perspectives, that require proven clinical efficacy. En bloc resection of bladder tumours may be advantageous, but is currently considered to be experimental.

The role of repeat transurethral resection in the management of high-risk superficial transitional cell bladder cancer

Tumour may recur because of the persistence of tumour after an incomplete TUR, a lesion that has been overlooked, a new lesion developed from circulating tumour cells during the TUR, or a true new occurrence caused by the growth of a microscopic lesion to a macroscopic one. An incomplete TUR will compromise the patient’s outcome, and therefore the recurrence rate at the first follow-up cystoscopy (RR-FFC). The early RRFFC between institutions is of major interest; Brausi et al. [2] analysed the variability among institutions in the RR-FFC in 2410 patients from seven phase III trials of the European Organisation for the Research and Treatment of Cancer (EORTC). The RR-FFC varied widely among institutions and could not be explained by tumour characteristics, number of tumours at TUR or the use of adjuvant intravesical instillations (Table 1) [2]. The authors suggested that these variations can only be attributed to the differing quality of the TUR performed by the various centres.

Is intravesical chemotherapy for superficial bladder cancer still justified

According to published reports, there is no doubt that intravesical chemotherapy has a statistically significant beneficial effect on time to recurrence and recurrence rate of superficial bladder cancer, as noted by the AUA guideline panel on nonmuscle-invasive bladder cancer [3]. However, the most critical endpoint of adjuvant prophylaxis is the increase in tumour-free survival due to reduction in disease recurrence or progression. In these respects, neither the Kaplan–Meier analysis by EORTC/MRC nor the meta-analysis by Lamm et al. showed any statistically significant difference between therapy and control arms [1,2]. To our knowledge, no available data show a statistically significant beneficial influence of intravesical chemotherapy on tumour progression in protocols comparing it with TUR alone [3]. The possible reasons for this will be discussed later.

Laparoscopic radical prostatectomy in the UK: defining and overcoming the obstacles.

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Modular Training in Endoscopic Extraperitoneal Radical Prostatectomy

Laparoscopic radical prostatectomy (LRPE) is one of the most technically demanding procedures in urology. However, the development and the standardisation of this technique have reached the point where many institutions no longer offer their patients the choice of open radical prostatectomy [1–6]. Thus one of the main focuses today is to evolve and ameliorate training facilities and establish teaching schemes for laparoscopic procedures in general and especially for this very complex operation.

Pelvic Lymphadenectomy in the Management of Prostate Cancer

In the era before prostate-specific antigen (PSA), when patients presented in advanced stages of prostate cancer, pelvic lymphadenectomy was the only available tool to provide staging information prior to commencement of surgical treatment for the prostate cancer. Contemporary imaging modalities such as bilateral pedal lymphangiography lacked sufficient sensitivity to replace surgical lymphnode staging.