EAU Update Series最新文献

{"title":"Technical Aspects of Radical Cystectomy","authors":"F.C. Hamdy","doi":"10.1016/j.euus.2005.07.006","DOIUrl":"10.1016/j.euus.2005.07.006","url":null,"abstract":"","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 3","pages":"Page 117"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.07.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86821483","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}

{"title":"Urinary Diversion Following Cystectomy","authors":"Udo Nagele,&nbsp;Karl-Dietrich Sievert,&nbsp;Axel S. Merseburger,&nbsp;Aristotelis G. Anastasiadis,&nbsp;Arnulf Stenzl","doi":"10.1016/j.euus.2005.07.003","DOIUrl":"10.1016/j.euus.2005.07.003","url":null,"abstract":"<div><p>Urinary diversion is an essential component of the surgical procedure after cystectomy. Replacement with an orthotopic ileal neobladder should be the first choice if external urethral sphincter sparing surgery is possible, offering good long-term function, quality of life and patient's acceptance with few complications.</p><p>The possible use of a variety of alternative intestinal segments widen the horizon of the reconstructive surgeon, allowing him or her to be prepared for unusual cases.</p><p>Contraindications for orthotopic neobladder reconstruction include tumour location, reduced renal, liver, intestinal function, intellectual ability and physical handicaps.</p><p>It is therefore important to custom tailor the appropriate mode of diversion for individual patients with a variety of options available, including ureterocutaneous stomas, intestinal conduits and continent catheterizable reservoirs and orthotopic neobladders. All these techniques require detailed knowledge of the possible metabolic problems encountered by using gastrointestinal segments and how they react in contact with urine. Modern surgical techniques such as nerve sparing surgery have the ability to preserve postoperative continence with voluntarily micturition as well as sexual function. In addition, preliminary experimental data hold great promise that the “off shelf” bladder substitute may become a technique of choice in the future, avoiding common problems encountered using current technqiues.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 3","pages":"Pages 129-137"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.07.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86339497","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}

{"title":"Laparoscopic Cystectomy – Evolution of A New Technique","authors":"Dimitri Vordos ,&nbsp;András Hoznek ,&nbsp;Matthew Gettman ,&nbsp;Clément-Claude Abbou","doi":"10.1016/j.euus.2005.07.005","DOIUrl":"10.1016/j.euus.2005.07.005","url":null,"abstract":"<div><p>Radical cystectomy remains one of the most invasive surgical procedures in urology, which can be associated with a high rate of complications, even in expert hands. These risks, together with the rapid advances in minimally invasive surgery stimulated the development of laparoscopic radical cystectomy. This is, however an evolving, relatively new procedure and to date, experience is limited to centers with established laparoscopic skills and established programmes. The main merit of the laparoscopic technique lies in the potential to reduce morbidity of the procedure. Although experience with laparoscopic radical cystectomy is limited in all reported series, especially when compared to open radical cystectomy, statistically significant advantages are emerging such as reduced blood loss, return to full diet, analgesic requirement and hospital stay.</p><p>Long term oncologic data are awaited. So far, only short term results based on margin status and lymph node involvement are available with limited follow-up. These results do not seem to differ significantly from open surgery and there is no evidence that laparoscopic access compromises oncologic safety.</p><p>Before this innovative technique will be considered as routine or standard, many technical innovations will be necessary to achieve acceptable operative times. Most importantly, long-term oncologic efficacy remains to be proven in large series of patients to establish laparoscopic radical cystectomy as a viable alternative to open radical cystectomy.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 3","pages":"Pages 147-155"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89085821","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}

{"title":"Cystectomy – Technical Considerations in Male and Female Patients","authors":"Arnulf Stenzl,&nbsp;Udo Nagele,&nbsp;Markus Kuczyk,&nbsp;Karl-Dietrich Sievert,&nbsp;Aristotelis Anastasiadis,&nbsp;Joerg Seibold,&nbsp;Stefan Corvin","doi":"10.1016/j.euus.2005.07.004","DOIUrl":"10.1016/j.euus.2005.07.004","url":null,"abstract":"<div><p>Simple and radical cystectomy for the treatment of benign and malignant bladder disease goes back to the late 19th century. The technique has changed over the last century due to increasing surgical experience, improvements in medical technology and pharmacology, an evolving technique of urinary diversion and an increase in patients demand for post-operative quality of life.</p><p>Approximately two decades ago the orthotopic bladder substitution became popular in male patients, whereas in female patients the use of an orthotopic neobladder to a remnant portion of the female urethra started only a decade ago and still does not include the majority of female patients undergoing cystectomy. The major goal of cystectomy for malignant disease in the pelvis is the oncological outcome. Without compromising tumour resection, however, functional results, i.e. continence, volitional voiding, potency and sexual intercourse play an increasingly important role for this type of surgery. This is especially important for a bladder confined disease which has a better long-term tumour outcome, but on the other hand the use of radical surgery for these stages is still debated in favour of more conservative bladder sparing forms of treatment with less favourable outcome.</p><p>The technique of radical cystectomy and lymphadenectomy both in male and female patients with regards to preservation of the urethra is outlined. In addition technique of sparing autonomic nerves both to the membranous urethra and the penis or the external and internal female genitalia is described. Surgical variations based on recent anatomic and clinical findings are presented and discussed with regards to the best functional outcome in male and female patients.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 3","pages":"Pages 138-146"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77037408","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}

{"title":"Introduction: Technical Aspects of Radical Prostatectomy","authors":"Axel Heidenreich","doi":"10.1016/j.euus.2005.03.007","DOIUrl":"10.1016/j.euus.2005.03.007","url":null,"abstract":"","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 61-62"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85664773","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}

{"title":"Indication, Technique and Outcome of Retropubic Nerve-Sparing Radical Prostatectomy","authors":"Markus Graefen ,&nbsp;Uwe H.G. Michl ,&nbsp;Hans Heinzer ,&nbsp;Martin G. Friedrich ,&nbsp;Christian Eichelberg ,&nbsp;Alexander Haese ,&nbsp;Hartwig Huland","doi":"10.1016/j.euus.2005.03.008","DOIUrl":"10.1016/j.euus.2005.03.008","url":null,"abstract":"<div><p>Retropubic radical prostatectomy is the most commonly used therapeutic option for the treatment of clinically localized prostate cancer. An ongoing stage migration towards organ-confined cancers allows to perform a nerve-sparing procedure in a growing number of patients. Key elements for achieving convincing functional results are a sphincter preserving ligation of the distal part of Santorini's plexus and the subtle preparation of the neurovascular bundle. This article gives a detailed description of our operative technique. Furthermore, a strategy for patient selection and tumor selection for the indication of nerve-sparing radical prostatectomy (NSRP) is suggested. In addition, functional results addressing postoperative urinary continence and potency are reported.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 77-85"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78809088","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}

{"title":"Laparoscopic Radical Prostatectomy: An Approach in Evolution","authors":"Hubert John","doi":"10.1016/j.euus.2005.03.003","DOIUrl":"10.1016/j.euus.2005.03.003","url":null,"abstract":"<div><p>Laparoscopic radical prostatectomy has become an attractive and exciting approach for the surgical treatment of localized prostate cancer. Two main routes are mainly used, namely the transperitoneal and the extraperitoneal approach. Minimal bleeding, shorter hospitalization and recovery time are unquestionable advantages for laparoscopic procedures. Oncological and functional results of laparoscopic prostatectomies today are comparable to those of the open retropubic standard technique. However, laparoscopic radical prostatectomy remains technically a difficult intervention and should be performed in selected centers with experienced teams. Robot assisted laparoscopic prostatectomy facilitates the procedure and in plus, it seems to improve oncological and functional results. Laparoscopic prostatectomy today is nearly equal to traditional retropubic prostatectomy, with certain outstanding advantages.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 86-89"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73493575","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}

{"title":"Radical Prostatectomy for Locally Advanced Prostate Cancer: Technical Aspects of Radical Prostatectomy","authors":"Chao-Yu Hsu,&nbsp;Steven Joniau,&nbsp;Hein Van Poppel","doi":"10.1016/j.euus.2005.03.004","DOIUrl":"10.1016/j.euus.2005.03.004","url":null,"abstract":"<div><p>The treatment of locally advanced prostate cancer is still matter of debate. While many years ago hormonal treatment (HT) was mostly applied, in recent years the combination of radiotherapy (RT) and HT has been more and more advocated. However, this treatment has never been shown in randomized controlled trials to be superior to surgery without or with adjuvant HT. The surgical approach by radical prostatectomy (RP) has often been discouraged although the results of RP in monotherapy for well-selected patients are excellent. Improvement in staging, a better selection of patients and expert surgery with extensive resection make RP a valuable adjuvant treatment option. Adjuvant therapy with either radiation or hormones can still be applied depending on the definitive pathology of the resected specimen.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 90-97"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76430965","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}

{"title":"The Role of Anatomic Extented Pelvic Lymphadenectomy in Men Undergoing Radical Prostatectomy for Prostate Cancer","authors":"Axel Heidenreich,&nbsp;Carsten H. Ohlmann","doi":"10.1016/j.euus.2005.03.006","DOIUrl":"10.1016/j.euus.2005.03.006","url":null,"abstract":"<div><p>The rationale for locoregional staging lymphadenectomy in prostate cancer lies in the accurate diagnosis of occult micrometastases in order to stratify patients who might benefit from adjuvant therapeutic measures. In prostate cancer, extended pelvic lymphadenectomy (EPLA) including the lymphatic tissue along the common iliac region with the ureteral crossing as cranial margin, external and internal iliac region and the obturator fossa has been shown to significantly increase the yield of both total lymph nodes and lymph node metastases. The total number of lymph nodes removed is about 2 to 3-fold higher and the frequency of micrometastatic lymph nodes is approximately 2-fold higher compared to standard lymphadenectomy. Furthermore, the frequency of observed positive lymph nodes in clinically localized and locally advanced prostate cancer is significantly higher than predicted by nomograms such as Partin tables and CART analysis. Although there are no prospective randomized trials demonstrating a survival benefit associated with EPLA, there might be an advantage for those with minimal lymph node involvement. Progression-free survival is significantly improved in patients undergoing EPLA with a 35% benefit compared to standard lymphadenectomy. Various studies have documented an equal risk of cancer associated mortality in patients with no or only 1–2 positive lymph nodes. Since the surgery associated morbidity of EPLA is not increased as compared to standard lymphadenectomy, EPLA should be favoured at least for all intermediate and high risk patients undergoing radical prostatectomy; in low risk patients the option of EPLA has to be discussed thoroughly. For the future, ongoing prospective trials have to demonstrate a clear benefit in terms of biochemical free and cancer specific survival.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 98-106"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79944709","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}

{"title":"Post-Operative Radiotherapy Following Radical Prostatectomy","authors":"Charles Catton","doi":"10.1016/j.euus.2005.03.005","DOIUrl":"10.1016/j.euus.2005.03.005","url":null,"abstract":"<div><p>Biochemical relapse will occur in 17–64% of men who undergo radical prostatectomy, and up to a third of men with biochemical relapse will progress to develop metastatic disease, and ultimately die of prostate cancer. Post-operative radiotherapy (RT) to the prostatic fossa is well-tolerated and potentially curative treatment, and should be considered for all men who have positive margins or biochemical relapse following prostatectomy. Gleason score &lt;8, PSA doubling time &gt;10 months and PSA re-emergence &gt;2 years following surgery predict for a low risk of early metastatic failure, but even men with no favourable prognostic factors may have a long-term durable response to RT, and should not be excluded from consideration of treatment on the basis of these factors alone. Improvements in radiation delivery with modern 3D conformal RT techniques and the integration of advanced imaging techniques such as MRI into the treatment planning process may improve tumor targeting and reduce normal-tissue toxicity for post-operative RT, and these require investigation. A positive anastamotic biopsy does not predict response to RT, and routine biopsy is not recommended. PSA level at time of RT is a strong indicator of durable response to RT, but no one PSA cut-point level appears to be more significant, and early RT is likely more effective than late. Adjuvant RT for a positive margin with an undetectable PSA offers the best opportunity to eradicate microscopic disease while tumor is localized and the tumor burden is lowest, but it also risks over-treating some men. Contemporary PSA assays can detect biochemical relapse in the 0.01–0.2 range, and this may provide additional therapeutic advantage if treatment can be given once relapse is proven and when tumour burden is small. There is an urgent need for prospective data from randomised trials to optimally select patients for adjuvant or salvage RT, to determine the optimal time to initiate treatment and to determine the role of adjunctive hormone therapy, and all patients should be considered for entry into ongoing and future clinical trials.</p></div>","PeriodicalId":100385,"journal":{"name":"EAU Update Series","volume":"3 2","pages":"Pages 107-116"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.euus.2005.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87265656","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}