Peter Amoroso

Bladder neck contracture after radical retropubic prostatectomy

To examine the incidence, management and outcome of vesico‐urethral anastomotic strictures after bladder‐neck sparing radical retropubic prostatectomy (RRP).

Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use: RISK FACTORS FOR INFECTION AFTER PROSTATE BIOPSY

Study Type – Prognosis (case series)

RECOGNIZING AND MANAGING THE COMPLICATIONS OF PROSTATE BIOPSY

Unusually for many solid organ tumours, localized prostate cancer is rarely diagnosed on imaging alone and usually requires a histological diagnosis of prostate tissue before potentially curative treatments are embarked upon. With increasing numbers of men becoming aware of their risk of developing prostate cancer and the escalating use of the PSA test, large numbers of men are undergoing prostate biopsy. Although usually carried out using trans-rectal ultrasound (TRUS) in an outpatient setting, there are a number of signifi cant risks and complications arising from this common procedure. Making patients aware of these complications and the symptoms they might present with is vital, as are clear instructions on how to re-access urological services if problems arise. Many can be potentially serious and, if left unrecognized, can result in signifi cant morbidity and at worst death. In the present paper, we aim to show the variety of presentation of these issues and their current optimum management, and Table 1 shows our recommendations.

Overcoming the challenges of robot-assisted radical prostatectomy

Robot-assisted radical prostatectomy (RARP) is the most commonly performed robotic procedure worldwide and is firmly established as a standard treatment option for localised prostate cancer. Part of the explanation for the rapid uptake of RARP is the reported gentler learning curve compared with the challenges of laparoscopic radical prostatectomy (LRP). However, robotic surgery is still fraught with potential difficulties and avoiding complications while on the steepest part of the learning curve is critical. Furthermore, as surgeons progress there is a tendency to take on increasingly complex cases, including patients with difficult anatomy and prior surgery, and these cases present a unique challenge. Significant intra-abdominal adhesions may be identified following open surgery, or dense periprostatic inflammation may be encountered following TURP; large prostate gland size and median lobes may alter bladder neck anatomy, making difficult subsequent urethro-vesical anastomosis. Even experienced robotic surgeons will be challenged by salvage RARP. Approaching these problems in a structured manner allows many of the problems to be overcome. We discuss some of the specific techniques to deal with these potential difficulties and highlight ways to avoid making serious mistakes.

Stop those anti‐platelet drugs before surgery!

atients presenting for urological surgery commonly take a combination of antiplatelet medications. Indications for drugs like aspirin, NSAIDs and the newer platelet inhibitors, e.g. platelet glycoprotein receptor inhibitors, are widespread because of the comorbidity in arterial disease associated with advancing age and general medical conditions in this population of patients. Medications are taken to reduce the risk of potentially catastrophic cardiovascular and cerebrovascular events.

SUPPORTING THE SUPPORTER: HELPING THE PARTNER OF PATIENTS NEWLY DIAGNOSED WITH PROSTATE CANCER

Prostate cancer will be diagnosed in > 35 000 men this year in the UK, and unfortunately ≈ 10 000 men will die from it. Although the early identification of this tumour can potentially save lives [1,2], the shock of receiving the bad news about the diagnosis, the difficulty selecting the best treatment option for that individual, and the problems associated with coming to terms with the effects of treatment may pose an enormous emotional challenge to the individual concerned. Nor is that individual solely impacted when prostate cancer strikes, his entire family are likely to be affected. In particular, his partner is likely to take the brunt of the emotional perturbation that frequently ensues from this anxietyprovoking diagnosis and from the effects of the treatment that is required.

AVOIDING AND DEALING WITH THE COMPLICATIONS OF ROBOT- ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

B J U I N T E R N A T I O N A L

GETTING TO A BETTER “PLACE”: HELPING PATIENTS COUNTER OBESITY BY ACHIEVING ENDURING LIFESTYLE CHANGE

COMMENT COMMENT GETTING TO A BETTER “PLACE”: HELPING PATIENTS COUNTER OBESITY BY ACHIEVING ENDURING LIFESTYLE CHANGE Roger Kirby*, Michael Kirby*, Peter Amoroso*, Ben Challacombe* ,† , Prokar Dasgupta*, Culley Carson III and John M. Fitzpatrick – *The Prostate Centre, London, Guys Hospital, King’s College London, King’s Health Partners, London, UK, University of North Carolina, Division of Urology, Chapel Hill, NC, USA, and The

Prevention and management of haematomata after minimally invasive radical prostatectomy.

Bleeding and subsequent haematoma formation can be a troublesome problem during and after radical prostatectomy, whichever way it is performed. The recent advent of laparoscopic radical prostatectomy, with or without robotic assistance, has significantly reduced intra-operative blood loss; however, after surgery haematomata may still develop, most often in the prostatic bed between the bladder and the rectum. In this location a sizeable blood clot may cause pain and tenesmus and discharge through the anastomosis into the bladder, resulting in haematuria, often with troublesome clots. It may also distort or even disrupt the anastomosis and significantly delay healing and hence time to catheter removal and the restoration of normal voiding.

Cardiopulmonary exercise testing in major urological surgery: an old test; a new perspective; a potential application

Preoperative assessment is a key component in major surgery. Assessing the functional capacity of a patient helps in preventing and managing predictable complications perioperatively. Historically there have been numerous objective and subjective methods used, e.g. 6-min walk test, stress echocardiogram or V-POSSUM (VascularPhysiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) in vascular surgery. We must now move beyond these traditional methods