You have accessJournal of UrologyProstate Cancer: Localized (VI)1 Apr 20131340 ONCOLOGIC AND FUNCTIONAL RESULTS IN SEMINAL VESICLE - NERVE SPARING RADICAL PROSTATECTOMY: OUR EXPERIENCE Mauro Mari, Stefano Guercio, Alessandra Ambu, Francesco Mangione, and Maurizio Bellina Mauro MariMauro Mari Rivoli- Torino, Italy More articles by this author , Stefano GuercioStefano Guercio Rivoli- Torino, Italy More articles by this author , Alessandra AmbuAlessandra Ambu Rivoli- Torino, Italy More articles by this author , Francesco MangioneFrancesco Mangione Rivoli- Torino, Italy More articles by this author , and Maurizio BellinaMaurizio Bellina Rivoli- Torino, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.03.051AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The early detection programs for prostate cancer have resulted in a downward stage migration and a marked decrease in the percentage of seminal vesicles(SV)involnment in prostatic carcinoma.There are very good reason to preserve the SV during radical prostatectomy to improve functional results. The cavernous nerves and the hypogastric plexus (IHP) are located very close to the tips of SV and around the SV. In the male the IHP is responsible for mechanism of erection, ejaculation and urinary continence.We evaluate the influence of the seminal vesicles-nerve sparing radical prostatectomy (SVNSRP) technique on recovery of urinary continence, erectile function and quality of orgasm. METHODS 145 informed consecutive patients (pts) with clinically localized prostate cancer(cT1c-T2a, PSA< 10 ng/ml; Gleason score <7, percentage positive biopsy < 33%)underwent SVNSRP. For inclusion all patients had be: aged <73 years; continent; potent; able to achieve orgasm, as deduced from a preoperative 5-item International Index of Erectile Function (IIEF-5) questionnaire, and be interested in recovery of postoperative sexual function. Main endpoints were: urinary continence evaluated the day after catheter removal and 1, 6 and 12 months postoperatively, sexual function and quality of orgasm evaluated preoperatively and 12 months. RESULTS The median follow-up is 32 months (range 16-102). Pathological stage was pT0 in 2/145 pts , pT2 in 123/145 pts, pT3 in 20/145. 19/145 pts had a focal positive surgical margins (11 pT3, 8 pT2). Immediately after catheter removal, one month, six months and twelve months postoperatively urinary continence rates were respectively 28%, 65%, 95% and 97%. 104/135 pts (77%) maintained sexual function, 64/135 pt (47%) without use of 5-phosphodiesterase inhibitors (used only during rehabilitation period or occasionally). Median time of recovery sexual function were 8 months. If we considered only pts were less than 66 years old (99/135), 80/99 (81%) maintained sexual function, whereas it was the case for 24/36 (66.6%) older patients (X2 p=0.08). The median preoperative IIEF- 5 score was 22 (range 16–25); at the 12-month follow-up the median IIEF-5 score was 19. 122/135 (90%) pts maintained the ability to achieve orgasm. CONCLUSIONS The SVNSRP, in our experiences, improved significantly early continence, erectile function, ability to achieve orgasm and its quality , without compromising cancer control in selected patients. Further prospective randomized studies with larger series of patients are required to confirm these results. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e547 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mauro Mari Rivoli- Torino, Italy More articles by this author Stefano Guercio Rivoli- Torino, Italy More articles by this author Alessandra Ambu Rivoli- Torino, Italy More articles by this author Francesco Mangione Rivoli- Torino, Italy More articles by this author Maurizio Bellina Rivoli- Torino, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

No AccessJournal of UrologyLetter to the Editor/Errata1 Mar 2012Re: Hydrodissection of Neurovascular Bundles During Open Radical Prostatectomy Improves Postoperative PotencyM. I. Patel, D. Spernat and E. Lopez-Corona J Urol 2011; 186: 233–237 Marizio Bellina, Mauro Mari, Alessandra Ambu, and Francesco Mangione Marizio BellinaMarizio Bellina More articles by this author , Mauro MariMauro Mari More articles by this author , Alessandra AmbuAlessandra Ambu More articles by this author , and Francesco MangioneFrancesco Mangione More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.10.163AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Hydrodissection of Neurovascular Bundles During Open Radical Prostatectomy Improves Postoperative Potency." The Journal of Urology, 187(3), p. 1136 References 1 : Hydrodissection of pelvic fascia during nerve-seminal sparing radical prostatectomy: hystological and functional results. Eur Urol2008; 7: 1. Google Scholar 2 : Seminal monolateral nerve-sparing radical prostatectomy in selected patients. Urol Int2005; 75: 175. Google Scholar 3 : The discovery of the cavernous nerves and development of nerve sparing radical retropubic prostatectomy. J Urol2007; 177: 1632. Link, Google Scholar 4 : Perfecting nerve-sparing radical prostatectomy: sailing in uncharted waters. Can J Urol2008; 15: 4230. Google Scholar Ospedale degli Infermi, Avigliana, Torino, Italy© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 3March 2012Page: 1136 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Marizio Bellina More articles by this author Mauro Mari More articles by this author Alessandra Ambu More articles by this author Francesco Mangione More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:To compare the safety and efficacy of emergency vs scheduled ureteroscopy with a prospective study that included patients who presented to the emergency department (ED) with renal colic from ureteral stones.PATIENTS AND METHODS:There were 271 consecutive patients who were enrolled in this prospective study. Patients were randomized to emergency ureteroscopy (group A) or delayed ureteroscopy (group B). All patients underwent helical unenhanced CT (HUCT). Stone-free status was defined as the complete absence of residual fragments at 1 week postoperatively, assessed with HUCT, with no need for ancillary interventions after ureteroscopy.RESULTS:Group A included 139 assessable patients. The overall stone-free rate was 93%. Neither location nor size was a significant prognostic factor (P>0.05). Single-session ureteroscopy failed to clear nine ureteral stones. A Double-J stent was placed in 27/139 patients. Group B included 100 assessable patients. Patients in the control group were scheduled for ureteroscopy after their departure from the ED. The overall stone-free rate was 90%. Single-session ureteroscopy failed to clear 10 ureteral stones. A Double-J stent was placed in 80/100 patients. There were no statistical differences with regard to stone diameter and location, complications, and stone-free rate between group A and group B patients. The rate of Double-J stent positioning was significantly higher (P<0.05) in group B patients.CONCLUSIONS:In our experience, emergency ureteroscopy showed equal efficacy and safety compared with the elective procedure. It has the main advantage of providing both immediate relief from pain and stone fragmentation.

It was reported that 11.1% of women undergo surgery for pelvic organ prolapse or urinary incontinence or both by the age of 80 years. The high rate of failure with conventional colporrhaphy for pelvic organ prolapse has led to an increasing use of synthetic and biological grafts in order to obtain more durable results. Problems associated with the use of mesh during vaginal surgery for pelvic organ prolapse include dyspareunia and mesh exposure. The aim of this video was to describe the treatment for a severe erosion of the bladder trigone by a prolene mesh.

No AccessJournal of UrologyLetter to the Editor/Errata1 Sep 2009Re: Is it Necessary to Remove the Seminal Vesicles Completely at Radical Prostatectomy? Decision Curve Analysis of European Society of Urologic Oncology CriteriaF. P. Secin, F. J. Bianco, A. Cronin, J. A. Eastham, P. T. Scardino, B. Guillonneau and A. J. Vickers J Urol 2009; 181: 609–614 Marizio Bellina, Alessandra Ambu, and Mauro Mari Marizio BellinaMarizio Bellina More articles by this author , Alessandra AmbuAlessandra Ambu More articles by this author , and Mauro MariMauro Mari More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.05.060AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Is it Necessary to Remove the Seminal Vesicles Completely at Radical Prostatectomy? Decision Curve Analysis of European Society of Urologic Oncology Criteria." The Journal of Urology, 182(3), p. 1233 References 1 : Seminal monolateral nerve-sparing radical prostatectomy in selected patients. Urol Int2005; 75: 175. Google Scholar 2 : Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer. J Urol1998; 160: 299. Link, Google Scholar Division of Urology, Ospedale Degli Infermi, Rivoli, Italy© 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 182Issue 3September 2009Page: 1233 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Marizio Bellina More articles by this author Alessandra Ambu More articles by this author Mauro Mari More articles by this author Expand All Advertisement PDF downloadLoading ...

Nowadays, because of early diagnosis of prostate cancer (PC) and the widespread use of nomograms to predict pathological stage of the tumour, seminal vesicle biopsy is considered as a useful tool only in case of clinical suspicion of seminal vesicle invasion. On the other hand, in last years some authors described their experience in less demolitive surgical procedures for PC, such as seminal sparing radical prostatectomy, in an attempt to improve both postoperative urinary continence and sexual function, as reported by Hauri and Montie, respectively. Patients, who may undergo to such procedure, could benefit from preoperative seminal vesicle biopsy, instead of rely on probability of seminal vesicle invasion indicated by nomograms only. From November 2001 to June 2003, 135 patients with negative rectal examination and PSA ≤10, with no contraindications to radical prostatectomy, underwent transrectal ultrasound guided seminal vesicle biopsy at our Institution. We performed seminal-monolateral nerve sparing radical prostatectomy in patients with monolateral PC, Gleason score <7 and <4 positive biopsy cores, without seminal vesicles involvement. Patients with seminal vesicle invasion were addressed to radiotherapy. Seminal vesicles biopsy showed in our hands good feasibility and low morbility; it was in general well tolerated by the patients. All biopsy cores were adequate for histological examination. Among patients with PC diagnosis, only one patient (4%), with serum PSA = 5 ng/mL and Gleason score = 6, had seminal vesicles involvement. We performed seminal-nerve sparing radical prostatectomy in 21 patients, neither histological examination on frozen section nor final pathology showed seminal vesicle invasion in any case. Real usefulness of seminal vesicle biopsy remains controversial, but due to its good feasibility and low morbility it may play a role in the staging of selected patients.

Introduction: In recent years there has been a shift in prostate cancer stage with the majority of patients nowadays being operated with cT1c disease, prostate-specific antigen levels of <10 ng/ml, and a decreased rate of seminal vesicle invasion. Recent data suggest the role of preservation of the seminal vesicle in improving continence and/or potency. We describe our preliminary experience with seminal-sparing, unilateral nerve-sparing retropubic radical prostatectomy. Patients and Methods: 21 selected patients with clinically localized prostate cancer underwent seminal unilateral nerve-sparing retropubic radical prostatectomy (seminal-sparing group, SSG). We compared the postoperative continence, erectile function and quality of orgasm results to those obtained in a control group (CG) of 21 patients who underwent unilateral nerve-sparing radical prostatectomy. Sexual function was evaluated preoperatively and 9 months postoperatively with the 5-item International Index of Erectile Function (IIEF-5) questionnaire and with oth er self-administered questionnaires. The quality of orgasm was evaluated 9 months postoperatively. Results: 1 month postoperatively, 95 and 28% of the patients in the SSG and CG were continent (p < 0.001). The median postoperative drop in IIEF-5 score was 5 points in SSG and 14.5 points in CG (p < 0.0001). Nine months postoperatively, 90 and 62% of the patients in SSG and CG, respectively (p = 0.05), maintained the ability to achieve orgasm. Conclusions: In our experience seminal-sparing radical prostatectomy showed good feasibility and improved early postoperative urinary continence, erectile function and quality of orgasm, without compromised cancer control.

According to some authors, residual tumour rate after superficial bladder cancer transurethral resection varies from 4–78%; among high risk superficial tumours (TaG3, T1G3, Tis) managed by transurethral resection of the bladder (TURB) and adjuvant immunotherapy, residual tumour rate varies from 57–76%. This study was aimed to evaluate residual tumour and/or tumour recurrence in 56 patients diagnosed with high risk superficial bladder tumour, who underwent transurethral resection, adjuvant 6-weekly course of intravesical bacille Calmette-Guérin (BCG) and second TURB on the first resection sites, and in other sites suspicious for recurrence. Overall, 7/56 patients (12.5%) had residual tumour and/or recurrent disease at second TURB; no histological progression was recorded. Disease persistence or recurrence was not related to tumour multifocality at first diagnosis. Our results appear to be consistent with other recent experiences, reporting low rates of residual tumour and disease progression in superficial bladder tumours after a first adequate resection and adjuvant immunotherapy. Thus, our current practice in management of high risk superficial bladder tumour is oriented towards routine cystoscopy within 3 months after first bladder tumour resection, completed by cold biopsies on previous resection sites. To our opinion, this approach provides adequate diagnostic reliability besides sparing the costs of a new resection and improving patients quality of life.