AIMTo determine the incidence of adenocarcinoma of the prostate for patients undergoing radical cystoprostatectomy for bladder cancer in Taiwan.

METHODSA total of 248 patients in Taiwan who were histologically confirmed for transitional cell carcinoma of the bladder underwent cystoprostatectomy. Histopathologic evaluation of the prostate specimens sectioned at 5 mm intervals was performed.

RESULTSOf the 248 patients, 10 (4.03%) were found to have prostate cancer. Of the 10 cases of unsuspected prostate cancer, eight proved to be at stage T1 or T2, and two at T3 and T4, respectively. This rate of incidentally found prostate cancer amongst our bladder cancer patients appeared to be lower than that found in bladder cancer patients in similar studies in USA.

CONCLUSIONAlthough the incidence of incidental prostate cancer in patients in Taiwan with bladder cancer is not high compared with that in Western countries, we suggest that digital rectal examination and prostate-specific antigen (PSA) are important screening tools for men with bladder cancer, especially for those aged 60 years and older in Taiwan.

Carcinoma, Transitional Cell ; pathology ; surgery ; Humans ; Male ; Neoplasm Staging ; Prostatectomy ; Prostatic Neoplasms ; complications ; surgery ; Urinary Bladder Neoplasms ; complications ; pathology ; surgery

Carcinoma, Adenosquamous ; complications ; diagnosis ; surgery ; Cystectomy ; Humans ; Male ; Middle Aged ; Prostatectomy ; Prostatic Neoplasms ; complications ; diagnosis ; surgery ; Urinary Bladder Neoplasms ; diagnosis ; secondary ; surgery

OBJECTIVETo investigate the surgical treatment of benign prostate hyperplasia (BPH) and its concomitant diseases at the same time.

METHODSOne hundred and fourteen operations were performed for BPH patients, including transurethral resection/vapor of the prostate (TURP/TUVP), inguinal herniorrhaphy, internal urethrotomy, transurethral resection of bladder tumor (TURBt) or vesical litholapaxy, and the data were reviewed.

RESULTSThe procedures were successful in all cases. A follow-up of 3 to 60 months found a good outcome of TURP. There was no recurrence in 30 cases of inguinal hernia and 39 cases of vesical calculus. Of the 25 cases of urethral stricture, 1 had an obvious hypotension during the operation and 4 needed urethral dilatation after operation. Six of the 20 cases of bladder tumor underwent a second TURBt due to the recurring tumor which was far from prostatic urethra.

CONCLUSIONInguinal hernia, urethral stricture, bladder tumor or vesical calculus can be treated simultaneously during TURP.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Hernia, Inguinal ; complications ; surgery ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; complications ; surgery ; Transurethral Resection of Prostate ; Urethral Stricture ; complications ; surgery ; Urinary Bladder Calculi ; complications ; surgery ; Urinary Bladder Neoplasms ; complications ; surgery

OBJECTIVETo evaluate the incidence and severity of perioperative complications in elderly patients with radical prostatectomy (RP).

METHODSA total of 242 patents underwent RP for prostate cancer were retrospectively assessed, whose clinicopathologic factors and perioperative complications were retrieved from the medical records. The mean age in the elderly group (n = 163) and control group (n = 79) were (73.2 ± 2.4) and (63.2 ± 4.8) years, respectively. The clinicopathologic factors including Charlson comorbidity index and preoperative prostate specific antigen were statistically significant different. The difference of clinicopathologic factors and perioperative complications between the elderly group (≥ 70 years old) and control group were statistically analyzed using the SPSS 17.0.

RESULTSThe incidence of perioperative complications was 23.5% in the elderly group and 22.7% in the control group. Except for gross hematuria (there were 12 cases in elderly group and 1 case in control group, respectively, χ(2) = 3.89, P < 0.05) and perioperative transfusion (there were 36 cases in elderly group and 7 cases in control group, respectively, χ(2) = 6.37, P < 0.05), there was no significant difference in each kind or total of perioperative complications.

CONCLUSIONThe elderly patients underwent RP in experienced center are not associated with higher or more serious perioperative complications.

Aged ; Humans ; Incidence ; Intraoperative Complications ; epidemiology ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Prostatectomy ; Prostatic Neoplasms ; surgery ; Retrospective Studies

OBJECTIVETo evaluate the effects and safety of transperitoneal laparoscopic radical prostatectomy (TLRP) and extraperitoneal laparoscopic radical prostatectomy (ELRP) in the treatment of localized prostate cancer.

METHODSWe searched the Cochrane Library, Medline, Chinese Journal Full-text Database, Wanfang and CBM for clinical controlled trials addressing TLRP and ELRP in the treatment of localized prostate cancer. Two independent reviewers extracted comparable data from eligible studies and performed meta-analysis with the Statal 2.0 software on the relevant indexes of operation time, intraoperative blood loss, postoperative catheterization, postoperative intestinal function recovery, and postoperative hospital stay.

RESULTSNine clinical controlled trials with 942 cases were included in this analysis, 492 treated by TLRP and the other 450 by ELRP. Meta-analysis showed no statistically significant differences between the TLRP and ELRP groups in operation time (SMD = 0.60, 95% CI: -0.06,1.26), intraoperative blood loss (SMD = 0.01, 95% CI: -0.35, 0.36) , postoperative catheterization time (SMD = 0.10, 95% CI: -0.21, 0.40) and postoperative hospital stay (SMD = 0.45, 95% CI: -0.01, 0.91), except in the time of postoperative intestinal function recovery, which was significantly shorter in the ELRP than in the TLRP group (SMD = 1.18, 95% CI: 0.26, 2.10).

CONCLUSIONFor the treatment of localized prostate cancer, ELRP is similar to TLRP with respect to operation time, intraoperative blood loss, postoperative catheterization and postoperative hospital stay, but superior to the latter in postoperative intestinal function recovery.

Blood Loss, Surgical ; Humans ; Laparoscopy ; Length of Stay ; Male ; Postoperative Complications ; Prostate ; surgery ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery

With the approaching of the aged society, the number of patients with BPH and those with prostate cancer is increasing, particularly the latter. As the gold standard for the treatment of the two diseases, prostate surgery falls into various types, each with its own characteristics in postoperative recovery of sexual function. In the past few years, the traditional laparotomy procedure has been gradually replaced by the laparoscopic technique. Doctors and patients are not merely satisfied with the improvement of micturition function any longer; they are beginning to pay more attention to the pre- and post-operative sexual function. This paper gives an overview of the influence of various types of prostatectomy on male sexual function.
Erectile Dysfunction ; etiology ; physiopathology ; prevention & control ; Humans ; Male ; Postoperative Complications ; etiology ; physiopathology ; prevention & control ; Prostatectomy ; adverse effects ; methods ; Prostatic Hyperplasia ; surgery ; Prostatic Neoplasms ; surgery

OBJECTIVETo study the diagnosis and treatment of prostate cancer after prostatectomy for benign prostatic hyperplasia (BPH).

METHODSTwelve cases of prostate cancer after prostatectomy for benign prostatic hyperplasia were reviewed and studied. The mean intervals between prostatectomy for BPH and the diagnosis of prostate cancer was 10 months to 14 years, 5.6 years on average. The main symptoms were dysuria, hematuria and pain. Serum prostate specific antigen (PSA) was elevated in 11 cases. Digital rectal examination (DRE) was abnormal in 8 cases. Three cases were in clinical stage B, 3 in stage C and 6 in stage D. Ten cases received combined androgen blockade therapy. Monotherapy with surgical castration was given to 2 cases. Three patients with urinary tract obstruction received additional treatment of TURP.

RESULTSDuring the 4 months to 8 years follow-up, 3 patients died, 6 remained stable and 2 deteriorated.

CONCLUSIONSurgery for BPH could not prevent the development of prostate cancer. PSA and DRE were the main methods for the diagnosis of this prostate cancer.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; surgery ; Prostatic Neoplasms ; diagnosis ; Retrospective Studies ; Transurethral Resection of Prostate

The incidence of prostatic cancer rises with increasing age and early diagnosis rate of the disease keeps increasing at the same time. Early diagnosis provides opportunities for radical prostatectomy to cure prostatic cancer. However, the problem of erectile dysfunction (ED) post operation puzzles urologists and exerts negative impacts on the patients life quality. Study on the prevention and treatment of peri-operational ED is of great importance to dwindle the occurrence rate of ED and is the key to improve the life quality of such patients.
Erectile Dysfunction ; etiology ; prevention & control ; Humans ; Male ; Phosphodiesterase Inhibitors ; therapeutic use ; Postoperative Complications ; Prostatectomy ; Prostatic Neoplasms ; surgery

OBJECTIVETo identify the rat cavernous nerve and establish a rat model of erectile dysfunction (ED) caused by injury of the cavernous nerve.

METHODSTwenty rats underwent dissections. Cavernous nerves were identified with the aid of an operating microscope and confirmed by electrical stimulation. Then, 42 experimental rats were randomized into 3 groups, including sham-operated controls and unilateral and bilateral cavernous nerve ablation groups. Three weeks after surgery, rat models were evaluated with the Apomorphine test.

RESULTSThe major pelvic ganglion lies on either side of the dorsolateral lobes of the prostate.It includes 2 inflows, one called hypogastric nerve and the other, the pelvic nerve. The largest outflow is termed the cavernous nerve. Stimulus parameters which could induce obvious penile erection were 5 volts, a frequency of 20 Hertz and a duration of 5 milliseconds. Three weeks after surgery, apomorphine could induce penile erection of each rat in the controls with a mean of 2.57 +/- 1.40 erections in 30 minutes, while there were no erections (0.00 +/- 0.00) in either the unilateral or bilateral groups.

CONCLUSIONSThe rat large ganglion and its cavernous nerve can be easily identified and it produces an obvious response to electrical stimulation. Rats are low cost animals to purchase, easy to house and very available making an ideal animal for developing an ED model caused by cavernous nerve injury. In addition, our study showed that in the early period of cavernous nerve ablation, unilateral and bilateral treated rats lost erectile capacity.

Animals ; Disease Models, Animal ; Erectile Dysfunction ; etiology ; Male ; Penis ; innervation ; Postoperative Complications ; etiology ; Prostatic Neoplasms ; surgery ; Rats ; Rats, Sprague-Dawley

BACKGROUNDIncidence of prostate cancer has been increasing in recent decades. In the year 2005, prostate cancer became the second most common cancer in males in Macau. The purpose of this report was to review and summarize the clinical features and prognosis of the 54 patients undergoing radical prostatectomy in Macau Special Administrative Region (SAR), China.

METHODSFrom November 2000 to November 2006, retropubic radical prostatectomy were performed in 54 cases for the treatment of prostate cancer. The mean age of patients was 69.8 years (range from 54 to 79). The preoperative prostate specific antigen (PSA) level, postoperative pathologic stage and Gleason's score, operation duration, intraoperative bleeding and intraoperative and postoperative complications were reported. The follow-up duration was 3 months to 6.25 years with a mean of 2.1 years. Postoperative parameters including PSA alteration, biochemical recurrence, local recurrence, distant metastasis and mortality were observed.

RESULTSMost of the patients in our study were diagnosed as localized prostate cancer. The patients' preoperative serum PSA was 0-4.0 ng/ml (16.7%), 4.0-10.0 ng/ml (51.8%), 10.1-20.0 ng/ml (24.1%) and above 20.0 ng/ml (7.4%). The TNM stage T1a+T1b comprised 7.6% of patients, stage T2a+T2b comprised 20.3%, stage T2c 38.9%, stage T3a 20.3% and over T3a only 12.9%. There were 9.5% cases with Gleason scores of 2-4, 41.5% with scores of 5-6, 30.2% with scores of 7 and 18.8% with scores of 8 - 10. The average operative duration was 216 minutes and the average intraoperative bleeding was 760 ml. Intraoperative complications included one massive hemorrhage (1.9%), one rectal injury (1.9%) and one obturator nerve injury (1.9%). Early postoperative complications consisted of urinary incontinence (14 cases, 25.9%), bladder neck stricture (5 cases, 9.3%), acute urinary retention (4 cases, 7.4%), pelvic effusion (2 cases, 3.8%), lymphocele (1 case, 1.9%) and vesicorectal fistula (only 1 case, 1.9%). For late postoperative complications, total incontinence or severe incontinence occurred in 6 cases (11.1%), urge incontinence in 2 cases (3.8%) and bladder neck contracture in 8 cases (14.8%). The total postoperative recurrence rate was 14.8%. Only 5 cases of biochemical recurrence were noted (9.3%). One case (1.9%) of local recurrence associated with elevated PSA was found. There were 2 cases of distant metastasis with elevated PSA (3.8%).

CONCLUSIONRadical prostatectomy is a safe and effective method for the treatment of localized prostate cancer in Macau.

Aged ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Prostatectomy ; adverse effects ; Prostatic Neoplasms ; surgery