Pub Date : 2019-02-12DOI: 10.5772/INTECHOPEN.79549
Y. I. Comez
Benign prostatic hyperplasia (BPH) is the most common benign tumor and cause of urinary retention in middle-aged male patients. Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for benign prostatic obstruction. Although widely performed, TURP is associated with significant morbidity. Open prostatectomy is performed in larger glands, which are more than 80 grams, with higher morbidity. Advances in technology, such as holmium laser enucleation of the prostate (HoLEP) and KTP laser vaporization, are other options that are widely used despite their limitations. Laparoscopic simple prostatectomy (LSP) is a minimally invasive treatment option with equivalent functional outcomes and is useful in larger prostatic adenomas, with low mor- bidity in experienced hands.
{"title":"Laparoscopic Simple Prostatectomy","authors":"Y. I. Comez","doi":"10.5772/INTECHOPEN.79549","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79549","url":null,"abstract":"Benign prostatic hyperplasia (BPH) is the most common benign tumor and cause of urinary retention in middle-aged male patients. Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for benign prostatic obstruction. Although widely performed, TURP is associated with significant morbidity. Open prostatectomy is performed in larger glands, which are more than 80 grams, with higher morbidity. Advances in technology, such as holmium laser enucleation of the prostate (HoLEP) and KTP laser vaporization, are other options that are widely used despite their limitations. Laparoscopic simple prostatectomy (LSP) is a minimally invasive treatment option with equivalent functional outcomes and is useful in larger prostatic adenomas, with low mor- bidity in experienced hands.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86940931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-29DOI: 10.5772/INTECHOPEN.82225
Genadiev Tsvetin Trifonov
The standard surgical treatment of obstructive symptoms of the lower urinary tract by benign prostatic hyperplasia is transurethral resection or classical simple prostatectomy. Inspired by our experience with laparoscopic radical prostatectomy and for the protection of urethra from stricture during prolonged transurethral resection, we studied the literature and started a prospective study for performing a laparoscopic simple prostatectomy. Following informed patient consent, we performed laparoscopic extraperitoneal simple prostatectomy in 17 patients with moderate to severe obstructive symptoms of benign prostatic hyperplasia with a prostate volume of over 80 ml. We did not find a laparoscopic technique for a simple prostatectomy which is the same as our method that we describe and publish. We called our method endoscopic extraperitoneal transvesicocapsular adenomectomy of prostate. We identified an abbreviation for the method of its popularization and systematic presentation, EETAP. In this chapter, we publish for the first time in the literature a minimally invasive surgical method for endoscopic extraperitoneal transvesicocapsular prostate adenоmectomy. We describe and publish the details of the method, the abbrevia tion of the method, an innovative learning protocol for its performance, as well as hypoth- eses for preoperative and intraoperative differential diagnosis. In our opinion, a multicenter study of this method could lead to its standardization in the broad urological practice.
{"title":"Endoscopic Extraperitoneal Transvesicocapsular Adenomectomy of Prostate (EETAP): A New Operative Method with an Innovative Learning Protocol for Its Performance","authors":"Genadiev Tsvetin Trifonov","doi":"10.5772/INTECHOPEN.82225","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82225","url":null,"abstract":"The standard surgical treatment of obstructive symptoms of the lower urinary tract by benign prostatic hyperplasia is transurethral resection or classical simple prostatectomy. Inspired by our experience with laparoscopic radical prostatectomy and for the protection of urethra from stricture during prolonged transurethral resection, we studied the literature and started a prospective study for performing a laparoscopic simple prostatectomy. Following informed patient consent, we performed laparoscopic extraperitoneal simple prostatectomy in 17 patients with moderate to severe obstructive symptoms of benign prostatic hyperplasia with a prostate volume of over 80 ml. We did not find a laparoscopic technique for a simple prostatectomy which is the same as our method that we describe and publish. We called our method endoscopic extraperitoneal transvesicocapsular adenomectomy of prostate. We identified an abbreviation for the method of its popularization and systematic presentation, EETAP. In this chapter, we publish for the first time in the literature a minimally invasive surgical method for endoscopic extraperitoneal transvesicocapsular prostate adenоmectomy. We describe and publish the details of the method, the abbrevia tion of the method, an innovative learning protocol for its performance, as well as hypoth- eses for preoperative and intraoperative differential diagnosis. In our opinion, a multicenter study of this method could lead to its standardization in the broad urological practice.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81908551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-09DOI: 10.5772/intechopen.81804
T. Genadiev
This short historical review shows the meaning of the prostate and the main points in the development of prostatectomy techniques through the centuries. The historical documents reveal the contribution of a large number of names of distinguished doctors and scholars from the ancient centuries to the present day. It is difficult to present this contribution in detail within an article, but it is possible to identify the main points of prostate surgery and their significance these days.
{"title":"Introductory Chapter: Prostatectomy - Challenge in the Past and Today","authors":"T. Genadiev","doi":"10.5772/intechopen.81804","DOIUrl":"https://doi.org/10.5772/intechopen.81804","url":null,"abstract":"This short historical review shows the meaning of the prostate and the main points in the development of prostatectomy techniques through the centuries. The historical documents reveal the contribution of a large number of names of distinguished doctors and scholars from the ancient centuries to the present day. It is difficult to present this contribution in detail within an article, but it is possible to identify the main points of prostate surgery and their significance these days.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82792009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79726
M. Rice, Tanya Stoyanova
Since its discovery, elevated prostate-specific antigen (PSA) has been the measurement to indicate possibility of prostate cancer, as well as biochemical recurrence following treatment. Although PSA has led to decrease in prostate cancer–related mortalities, PSA is a nonspe - cific prostate cancer biomarker reflective of other prostate-related conditions such as benign prostatic hyperplasia (BPH), resulting in a high false-positive rate. This has led to overtreat - ment of men with clinically insignificant disease. While most prostate cancer patients have slowly progressive disease and should be treated conservatively, roughly 10% of patients will progress to have metastatic disease, of which the majority of prostate cancer deaths can be attributed. Stratifying these patients based on prognosis so that they may benefit from aggressive treatment is critical to their survival. Biomarkers for prostate cancer diagnosis and subsequent prognostic screening have significantly advanced this field. Here, we review some of the current blood, tissue, and urine biomarker tools used to measure an array of molecules including DNA, RNA, protein, or even epigenetic modifications. Utilizing the technologies described here, as well as looking to the future, correct early identification of prostate cancer with powerful prognostic value is much closer than ever before. to its androgen independent function, AR-V7 has been implicated in the resistance to second-generation anti-androgen therapies. be tumor (CTCs) is with to second including and , the as a selection biomarker.
{"title":"Biomarkers for Diagnosis and Prognosis of Prostate Cancer","authors":"M. Rice, Tanya Stoyanova","doi":"10.5772/INTECHOPEN.79726","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79726","url":null,"abstract":"Since its discovery, elevated prostate-specific antigen (PSA) has been the measurement to indicate possibility of prostate cancer, as well as biochemical recurrence following treatment. Although PSA has led to decrease in prostate cancer–related mortalities, PSA is a nonspe - cific prostate cancer biomarker reflective of other prostate-related conditions such as benign prostatic hyperplasia (BPH), resulting in a high false-positive rate. This has led to overtreat - ment of men with clinically insignificant disease. While most prostate cancer patients have slowly progressive disease and should be treated conservatively, roughly 10% of patients will progress to have metastatic disease, of which the majority of prostate cancer deaths can be attributed. Stratifying these patients based on prognosis so that they may benefit from aggressive treatment is critical to their survival. Biomarkers for prostate cancer diagnosis and subsequent prognostic screening have significantly advanced this field. Here, we review some of the current blood, tissue, and urine biomarker tools used to measure an array of molecules including DNA, RNA, protein, or even epigenetic modifications. Utilizing the technologies described here, as well as looking to the future, correct early identification of prostate cancer with powerful prognostic value is much closer than ever before. to its androgen independent function, AR-V7 has been implicated in the resistance to second-generation anti-androgen therapies. be tumor (CTCs) is with to second including and , the as a selection biomarker.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81678779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79398
Michael J. Whalen
Erectile dysfunction is a known and much-dreaded functional consequence of radical prostatectomy. Dr. Patrick Walsh pioneered the nerve-sparing radical retropubic prostatectomy in the early 1980s, which has mitigated the morbidity of this surgery. Post- operative potency rates range widely from 20 to 80%, however, and depend on myriad factors including age, preoperative potency, and degree of nerve-sparing during surgery. Over the past four decades several developments have continued to offer hope to patients and clinicians alike, including refined understanding of cavernosal nerve neuroanatomy, beneficial modifications in surgical technique, as well as the advent of robotic surgery. Furthermore, multiple pre- and post-operative penile rehabilitation techniques using mechanotherapy and pharmaceuticals have also improved functional recovery. This paper examines erectile dysfunction as a consequence of radical prostatectomy, including the physiology of erections, the pathophysiology of post-operative erectile dysfunction, novel surgical techniques to enhance neurovascular bundle preservation, and penile reha- bilitation strategies involving hyperbaric oxygen, neuroprotective pharmaceuticals, dehydrated human amnion-chorion membrane allografts, and mesenchymal stem cell therapy.
{"title":"Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies","authors":"Michael J. Whalen","doi":"10.5772/INTECHOPEN.79398","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79398","url":null,"abstract":"Erectile dysfunction is a known and much-dreaded functional consequence of radical prostatectomy. Dr. Patrick Walsh pioneered the nerve-sparing radical retropubic prostatectomy in the early 1980s, which has mitigated the morbidity of this surgery. Post- operative potency rates range widely from 20 to 80%, however, and depend on myriad factors including age, preoperative potency, and degree of nerve-sparing during surgery. Over the past four decades several developments have continued to offer hope to patients and clinicians alike, including refined understanding of cavernosal nerve neuroanatomy, beneficial modifications in surgical technique, as well as the advent of robotic surgery. Furthermore, multiple pre- and post-operative penile rehabilitation techniques using mechanotherapy and pharmaceuticals have also improved functional recovery. This paper examines erectile dysfunction as a consequence of radical prostatectomy, including the physiology of erections, the pathophysiology of post-operative erectile dysfunction, novel surgical techniques to enhance neurovascular bundle preservation, and penile reha- bilitation strategies involving hyperbaric oxygen, neuroprotective pharmaceuticals, dehydrated human amnion-chorion membrane allografts, and mesenchymal stem cell therapy.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84775962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79364
K. Araki, Y. Naya
Robot-assisted laparoscopic prostatectomy (RALP) is more popular than laparoscopic radical prostatectomy (LRP) in twenty-first century. However, RALP is still an expen sive surgery. Open radical prostatectomy (ORP) was a gold standard and not an expen - sive surgery. However, ORP is not minimum invasive. LRP is relative expensive and minimum invasive. The problem of RALP or LRP is necessary to spread the wound for removing prostate and the pain of wound is often a problem. Using U-shaped incision at umbilicus, spreading the wound is not necessary to remove prostate. Single-port surgery is a challenging procedure for surgeons in spite of faster recovery and higher patient satisfaction than conventional laparoscopy. Adding one or two port, reduced port sur - gery is easier than single-port surgery. Reduced port LRP is an extension of conventional LRP. The procedure is as same as conventional LRP. Curved or flexible instruments are not always necessary in the reduced port LRP. Reduced port LRP has less pain and better cosmetics than conventional LRP because the prostate is removed from the umbilicus. It is not necessary to spread the wound for removing prostate.
{"title":"Reduced Port Extraperitoneal Laparoscopic Radical Prostatectomy","authors":"K. Araki, Y. Naya","doi":"10.5772/INTECHOPEN.79364","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79364","url":null,"abstract":"Robot-assisted laparoscopic prostatectomy (RALP) is more popular than laparoscopic radical prostatectomy (LRP) in twenty-first century. However, RALP is still an expen sive surgery. Open radical prostatectomy (ORP) was a gold standard and not an expen - sive surgery. However, ORP is not minimum invasive. LRP is relative expensive and minimum invasive. The problem of RALP or LRP is necessary to spread the wound for removing prostate and the pain of wound is often a problem. Using U-shaped incision at umbilicus, spreading the wound is not necessary to remove prostate. Single-port surgery is a challenging procedure for surgeons in spite of faster recovery and higher patient satisfaction than conventional laparoscopy. Adding one or two port, reduced port sur - gery is easier than single-port surgery. Reduced port LRP is an extension of conventional LRP. The procedure is as same as conventional LRP. Curved or flexible instruments are not always necessary in the reduced port LRP. Reduced port LRP has less pain and better cosmetics than conventional LRP because the prostate is removed from the umbilicus. It is not necessary to spread the wound for removing prostate.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88539208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79125
W. Chan, C. Kan, Churk Fai Trevor Li
Large benign prostatic enlargement (BPE) has been a major health problem and the surgi- cal management could be technically challenging to urologists due to the limitation of conventional monopolar transurethral resection of prostate. Bipolar endoscopic enucle- ation of prostate aimed to remove the adenoma of BPE by stepwise adenoma devascularization and maximal adenoma removal through minimally invasive surgery. In this chapter we described the general principle, the surgical techniques of bipolar endoscopic enucleation and the related modifications of the technique in the recent years. As com - pared with open prostatectomy, bipolar endoscopic enucleation avoided the wound complications but achieved similar functional outcome. Bipolar endoscopic enucleation also allowed much more adenoma removal comparing with transurethral resection of the prostate. Unlike Holmium laser or thulium laser enucleation of the prostate, the required instruments for bipolar endoscopic enucleation of the prostate were familiar and more readily available to most urologists.
{"title":"Bipolar Endoscopic Enucleation of Big Benign Prostate Enlargement","authors":"W. Chan, C. Kan, Churk Fai Trevor Li","doi":"10.5772/INTECHOPEN.79125","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79125","url":null,"abstract":"Large benign prostatic enlargement (BPE) has been a major health problem and the surgi- cal management could be technically challenging to urologists due to the limitation of conventional monopolar transurethral resection of prostate. Bipolar endoscopic enucle- ation of prostate aimed to remove the adenoma of BPE by stepwise adenoma devascularization and maximal adenoma removal through minimally invasive surgery. In this chapter we described the general principle, the surgical techniques of bipolar endoscopic enucleation and the related modifications of the technique in the recent years. As com - pared with open prostatectomy, bipolar endoscopic enucleation avoided the wound complications but achieved similar functional outcome. Bipolar endoscopic enucleation also allowed much more adenoma removal comparing with transurethral resection of the prostate. Unlike Holmium laser or thulium laser enucleation of the prostate, the required instruments for bipolar endoscopic enucleation of the prostate were familiar and more readily available to most urologists.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80916610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79157
E. Eppard
In recent years, the positron emitter scandium-44 moved into the focus of research pro- viding favorable nuclide properties for an application in nuclear medicine. Radiolabeling of PSMA-617 with scandium-44 as diagnostic match for [ 177 Lu]Lu-PSMA-617 instead of gallium-68 would enable pre-therapeutic dosimetry in clinical setting. Due to the chemical similarities of scandium and lutetium, the in vitro and in vivo characteristics of [ 177 Lu]Lu-PSMA-617 are more similar to [ 44 Sc]Sc-PSMA-617 than to the 68 Ga-compounds [ 68 Ga]Ga-PSMA-617 or [ 68 Ga]Ga-PSMA-11. [ 44 Sc]Sc-PSMA-617 showed its potential in a clinical setting as a PET imaging agent of prostate cancer providing several advan- tages over gallium-68 labeled tracers. The longer half-life of the nuclide would allow, for example, an optimized patient management and treatment, long-term or late time point imaging as well as transportation to more distant PET centers. However, especially clinical applications like individual dosimetry or intraoperative applications are still under investigation.
{"title":"Pre-Therapeutic Dosimetry Employing Scandium-44 for Radiolabeling PSMA-617","authors":"E. Eppard","doi":"10.5772/INTECHOPEN.79157","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79157","url":null,"abstract":"In recent years, the positron emitter scandium-44 moved into the focus of research pro- viding favorable nuclide properties for an application in nuclear medicine. Radiolabeling of PSMA-617 with scandium-44 as diagnostic match for [ 177 Lu]Lu-PSMA-617 instead of gallium-68 would enable pre-therapeutic dosimetry in clinical setting. Due to the chemical similarities of scandium and lutetium, the in vitro and in vivo characteristics of [ 177 Lu]Lu-PSMA-617 are more similar to [ 44 Sc]Sc-PSMA-617 than to the 68 Ga-compounds [ 68 Ga]Ga-PSMA-617 or [ 68 Ga]Ga-PSMA-11. [ 44 Sc]Sc-PSMA-617 showed its potential in a clinical setting as a PET imaging agent of prostate cancer providing several advan- tages over gallium-68 labeled tracers. The longer half-life of the nuclide would allow, for example, an optimized patient management and treatment, long-term or late time point imaging as well as transportation to more distant PET centers. However, especially clinical applications like individual dosimetry or intraoperative applications are still under investigation.","PeriodicalId":20788,"journal":{"name":"Prostatectomy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80301301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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